食管癌放疗后局部淋巴结转移行伽马刀治疗联合化疗的疗效分析

Clinical analysis on the body gamma knife combined with chemotherapy foresophageal carcinoma complicated with loco-regional lymph node metastasis after radiotherapy

目的分析临床无远处转移食管鳞癌患者接受根治性放疗后出现锁骨上或纵隔淋巴结转移行伽马刀治疗联合化疗的疗效和相关不良反应。方法回顾性分析经治的45例接受根治性放疗后出现锁骨上或纵隔淋巴结转移的食管鳞癌患者,分为联合组和对照组;2组均给予伽马刀治疗,联合组给予紫杉醇和奈达铂化疗。结果联合组和对照组总有效率分别为90.9%和65.2%(P<0.05);气管受侵或受压变形总缓解率分别为90.9%和50.0%(P<0.05),声音嘶哑、进食梗阻和疼痛总缓解率差异无统计学意义(P>0.05);1年总生存率分别为86.4%和56.5%(P<0.05),3年和5年后总生存率差异无统计学意义(P>0.05);放射性食管炎和放射性肺炎发生率差异均无统计学意义(P>0.05),骨髓抑制发生率分别为72.7%和34.8%(P<0.05),消化道反应发生率分别为72.7%和39.1%(P<0.05)。结论伽马刀治疗联合紫杉醇及奈达铂化疗能显著提高缓解率,缓解气管受侵或受压变形的症状,提高短期生存率,但在提高长期生存率方面无显著优势,有增加骨髓抑制和消化道反应的风险。

Objective To analyse the effects and adverse reactions of the body gamma knife combined with chemotherapy for esophageal carcinoma without of clinical distant metastasis complicated but with supraclavicular or mediastinal lymph node metastasis after radiotherapy. Methods 45 patients were divided into combined group and control group. Two groups were treated with the body gamma knife, and combined group were treated with paclitaxel and nedaplatin by intravenous injection. Results The short-term ef- fective rates of combined group and control group were 90.9% and 65.2% respectively （P〈0.05）.The remission rates of tracheal inva- sion or compression were 90.9% and 50.0% （P〈0.05）.There was no statistical difference in remission rates of hoarse voice, eating ob- struction and pain （P〉0.05）. The 1-year survival rates were 86.3% and 56.5% （P〈0.05）, but there was no statistical difference in 3- year and 5-year survival rates（P〉0.05）. There were no statistical differences in occurrence rates of radiation esophagitis and radiation pneumonitis（P〉0.05）. The occurrences rate of bone marrow suppression were 72.7% and 34.8% （P〈0.05）, and the occurrences of digestive tract reaction were 72.7% and 39.1% （P〈0.05）. Conclusion The body gamma knife combined with paclitaxel and neda- platin can significantly improve short-term effective rate, remission rate of tracheal invasion or compression and 1-year survival rate,improve long-term increase the occun＇ence rate digestive tract reaction survival rate, moreover, it can of bone marrow suppression and