调强适形放疗联合化疗治疗局部晚期非手术食管癌患者的临床研究

Clinical Study of Intensity Modulated Radiotherapy Combined with Chemotherapy in the Treatment of Non-surgical Patients with Locally Advanced Esophageal Carcinoma

目的探讨调强适形放疗联合化疗治疗局部晚期非手术食管癌患者的可行性及疗效。方法 83例局部晚期非手术食管癌患者作为研究对象,随机数字表法分为观察组(n=42)与对照组(n=41)。观察组采用调强适形放疗联合化疗,对照组应用二维放疗技术联合化疗,比较两组治疗有效率、不良反应发生率及1年、2年生存率与复发率。结果观察组治疗有效率为81.0%(34/42),较对照组[75.60%(31/41)]稍高,但差异无统计学意义(P>0.05)。两组不良反应均以骨髓抑制、恶心、呕吐、放射性食管炎、放射性肺炎、放射性肺纤维化为主,其中骨髓抑制、恶心呕吐、放射性食管炎等急性不良反应组间差异均无统计学意义(P>0.05);观察组放射性肺炎、放射性肺纤维化发生率分别为9.5%、19.0%,低于对照组(26.8%、39.0%),晚期不良反应组间差异有统计学意义(P<0.05)。两组1年与2年生存率及随访结束时的复发率等远期疗效指标比较均无统计学意义(P>0.05)。结论调强适形放疗联合化疗治疗局部晚期非手术食管癌患者的近期效果满意,与对照组相比较肺组织不良反应明显减少,提高了生存质量,值得临床推广。

Objective To explore the feasibility and curative effect of intensity modulated radiotherapy combined with chemotherapy in. the treatment of non-surgical patients with locally advanced esophageal carcinoma. Methods 83 non-surgical patients with locally advanced esophageal carcinoma were taken as the research objects. According to the random number table method, the patients were divided into the observation group （n = 42）and the control group （n = 41 ）. The observation group was treated by intensity modulated radiotherapy combined with chemotherapy while the control group was treated by two-dimensional radiotherapy combined with chemotherapy. The effective rates, the incidence rates of side effects, 1-year and 2-year survival rates and recurrence rates were compared between the 2 groups. Results The effective rate in the observation group was [ 81.0% （34/ 42） ] while the control group was [75.60% （31/41） ] （P 〉0.05）. The main side effects of the 2 groups were myelosuppression, nausea and vomiting, radiation esophagitis, radiation pneumonitis and radiation-induced lung fibrosis. Besides, there was no significant differences in the incidence rates of myelosuppression, nausea and vomiting and radiation esophagitis between groups （P 〉 0.05）. The incidence rates of radiation pneumonitis and radiation-induced lung fibrosis in the observation group （9.5%, 19.0% ）were lower than those in the control group （26.8% ,39.0% ） （P 〈0.05）. The differences in 1-year and 2-year survival rates, the recurrence rates at the end of the follow-up and other long-term curative effect indexes were not statistically significant （ P 〉 0.05）. Conclusion Intensity modulated radiotherapy combined with chemotherapy in the treatment of non-surgical patients with locally advanced esophageal carcinoma has satisfying short-term effects. Compared with two-dimensional radiotherapy combined with chemotherapy, the side effects such as radiation pneumonitis and radiation-induced lung fibrosis are significantly fewer. It is worthy of clinical promotion.