诱导化疗联合同步放化疗治疗进展期食管癌的疗效分析

Efficacy of induction chemotherapy combined with concurrent chemo-radiotherapy for advanced esophageal cancer

目的分析以诱导化疗联合同步放化疗治疗进展期食管癌的疗效、预后因素和毒副反应,初步探讨进展期食管癌治疗新模式。方法对2010年4月~2014年7月在我科接受诱导化疗联合同步放化疗的35例随访资料完整的进展期食管癌患者进行回顾性分析。结果全部35例患者中,完全缓解（complete response,CR）5例（14.3%）,部分缓解（partial response,PR）24例（68.6%）,稳定（stable disease,SD）6例（17.1%）,进展（progressive disease,PD）0例,总有效（CR＋PR＋SD）35例（100.0%）。至随访截止（2016年7月30日）,19例患者出现疾病进展,其中13例（37.1%）区域复发,4例（11.4%）远处转移,2例（5.7%）区域＋远处转移。1、2年无疾病生存率（progression-free survival,PFS）分别为57.1%（20/35）、37.1%（13/35）,1、2年总生存率（overall survival,OS）分别为85.7%（30/35）、62.9%（22/35）。多因素分析提示性别、年龄、诱导化疗方案、同步放化疗肿瘤靶区（gross tumor volume,GTV）剂量、同步放化疗后疗效为影响预后的因素。结论诱导化疗联合同步放化疗可作为进展期食管癌的治疗方法,治疗耐受尚可,但仍需前瞻性对照研究进一步证实。

Objective To analyze the clinical efficacy, prognostic factors and side effects of induction chemotherapy combined with concurrent chemoradiotherapy for advanced esophageal cancer, and to explore the new mode of treatment for advanced esophageal cancer. Methods A total of 35 cases of advanced esophageal cancer patients with complete follow-up data, who received induction chemotherapy combined with concurrent chemoradiotherapy in our department from April 2010 to July 2014, were retrospectively analyzed. Results Among 35 patients, 5 patients achieved complete response（CR）（14.3%）; 24 patients achieved partial response（PR）（68.6%）; 6 patients with stable disease（SD）（17.1%） and 0 case with progressive disease（PD）; and the number of overall effective（CR ＋PR ＋SD） was 35 cases（100.0%）. Until the cut-off date 30 July 2016 of the follow-up, 19 patients had disease progression, including 13 cases（37.1%） with regional recurrence, 4 cases（11.4%） with distant metastases, and 2 cases（5.7%） with regional and distant metastases. The progression-free survival（PFS） of 1 year and 2 years were 57.1%（20/35） and 37.1%（13/35）, respectively; and the overall survival（OS） of 1 year and 2 years were 85.7%%（30/35）, 62.9%（22/35）. Multivariate analysis showed that sex, age, induction chemotherapy regimen, dose of concurrent chemotherapy of gross tumor volume（GTV）,and the efficacy of concurrent radiotherapy and chemotherapy were prognostic factors. Conclusion Induction chemotherapy combined with concurrent chemoradiotherapy can be used as a treatment for advanced esophageal cancer, tolerance of which is acceptable, but it is still need to be further confirmed by prospective controlled study.