紫杉联合氟尿嘧啶一线化疗在食管癌综合治疗中的疗效及安全性研究

Therapeutic effect and safety of taxane combined with fluorouracil as first-line chemotherapy in combined modality therapy of esophageal cancer

目的分析以紫杉联合氟尿嘧啶为一线化疗的综合治疗模式在食管癌治疗中疗效及血液学毒性。方法回顾性分析扬州大学临床医学院收治初治或单纯术后复发转移的食管癌40例,采用紫杉联合氟尿嘧啶或其衍生物单纯化疗或联合放疗,分析紫杉联合氟尿嘧啶化疗的治疗疗效及血液学毒性。结果全组40例患者经过治疗后,总体疗效为:CR 2例,PR 21例,SD 13例,PD 4例,有效率为57.50%,疾病控制率为90.00%。全组有11例患者接受单纯化疗,治疗后有效率为27.27%,疾病控制率为81.82%。血液学毒性主要为白细胞低下,Ⅲ~Ⅳ级白细胞低下的发生率为18.18%。29例放化疗治疗后,有效率为68.97%,疾病控制率为93.10%。血液学毒性主要为白细胞低下,Ⅲ~Ⅳ级白细胞低下的发生率为24.14%。29例放化疗患者中,有16例接受同步放化疗,13例患者接受诱导化疗后行放化疗。与诱导化疗组相比,同步放化疗组具有更高的有效率和CR率,但未见统计学差异(P>0.05),血液学毒性方面两组未见差异(P>0.05)。结论在食管癌综合治疗中,紫杉类药物联合氟尿嘧啶是一个安全有效的一线化疗方案,值得进一步临床研究探讨。

Objective To investigate the therapeutic effect and hematological toxicity of taxane combined with fluorouracil as first-line chemotherapy in combined modality therapy of esophageal cancer. Methods The clinical data about 40 patients who were newly diagnosed or postoperatively recurred in our hospital from November 2011 to December 2014 were retrospectively analyzed. These patients were treated by taxane combined with fluorouracil or and its derivant. The therapeutic effect and hematological toxicity were observed and analyzed. Results The response rate （ RR） and disease control rate was 57. 50% and 90. 00% , respectively in all the 40 patients （ CR 2cases,PR 21 cases,SD 13 cases and PD 4 cases） . Among 40 patients, 11 patients received chemotherapy only, and the RR and disease control rate was 27. 27% and 81. 82% , respectively. The hematologic toxicity was mainly neutropenia, with the incidence rate of grade IH/IV neutropenia being 18.18%,and the other 29 patients received concurrent chemoradiotherapy. After treatment, RR and disease control rate was 68.97% and 93.10% , respectively. The main hematologic toxicity was neutropenia, with the incidence rate of grade IH/IV neutropenia being 24. 14%. Among the 29 patients receiving chemoradiotherapy, 16 patients received concurrent chemoradiotherapy and 13 patients received induction chemotherapy before chemoradiotherapy. As compared with the patients in induction chemotherapy group,the patients in concurrent chemoradiotherapy group had higher effective rate and CR rate, however, there were no significant differences between the two groups （ P 〉 0 .05 ） . Furthermore, there were no significant differences in hematologic toxicities between the two groups （ P 〉 0. 05 ） . Conclusion The taxane combined with fluorouracil is effective and safe in the first line chemotherapy of esophageal cancer,which is worthy researching further.