同步放化疗与序贯放化疗对晚期食管癌的临床疗效分析

Efficacy of concurrent radiochemotherapy versus sequential radiochemotherapy for advanced esophageal cancer

目的探讨同步放化疗和序贯放化疗对晚期食管癌患者生存期和并发症等临床疗效的差异。方法选取2013年4月至2015年4月间江苏省泰州巿第二人民医院收治的82例晚期食管癌患者,采用随机数表法分为同步放化疗组和序贯放化疗组,每组41例。观察并比较两组患者的生存期、生活质量、病灶缓解情况和不良反应情况。结果同步组1~2年生存率低于序贯组,>2年生存率大于序贯组,差异均有统计学意义(均P<0.05)。两组患者<1年生存率比较,差异无统计学意义(P>0.05)。序贯组患者中位生存期和进展期分别为17.3个月和12.5个月,同步组患者的中位生存期和进展期分别为22.3个月和14.2个月。同步组患者的吞咽哽咽感、呕血和胸骨后疼痛方面评分均高于序贯组患者,差异均有统计学意义(均P<0.05)。同步组客观缓解率(ORR)和疾病控制率(DCR)均大于序贯组,差异均有统计学意义(均P<0.05)。两组患者在治疗期间均无IV度不良反应发生;序贯组0度和I度放射性食管炎、0度血液毒性及0度和I度胃肠道毒副作用发生例数多于同步组,差异有统计学意义(P<0.05)。结论采用同步和序贯放化疗治疗晚期食管癌安全性良好,但同步放化疗在提高晚期食管癌患者生存期,改善生活质量和疾病疗效方面优于序贯放化疗。

Objective To analyze the difference in the clinical efficacy between concurrent radiochemotherapy and sequential radiochemotherapy in patients with advanced esophageal cancer. Methods A total of 82 patients with advanced esophageal cancer were selected at Taizhou Second People＇s Hospital from April 2013 to April 2015. Using a random number table,patients were divided into concurrent radiochemotherapy group and sequential radiochemotherapy group with 41 patients in each group. The survival,quality of life,remission and adverse reactions were observed. Results The 1-to 2-year survival was lower in the concurrent group than in the sequential group and the 2-year survival was higher in the concurrent group than in the sequential group（ all P〈0. 05）. There was no significant difference in the less than 1-year survival between the two groups（ P〈0. 05）. The median survival and time to progression was 17. 3 months and 12. 5 months,respectively for the sequential group and 22. 3 months and 14. 2 months,respectively for the concurrent group. Scores of choking and Difficulty swallowing,hematemesis and retrosternal pain were higher in the concurrent group than in the sequential group（ all P〈0. 05）. Objective response rate（ ORR） and disease control rate（ DCR） were higher in the concurrent group than in the sequential group（ all P〈0. 05）. No grade IV adverse reaction occurred in either of the two groups. However,the incidence of grade 0 and grade I radiation esophagitis,grade 0 blood toxicity and grade I gastrointestinal side effects was higher in the sequential group than in the concurrent group. Conclusion Concurrent and sequential radiochemotherapy for the advanced esophageal cancer has good safety and concurrent radiochemotherapy is superior to sequential radiochemotherapy in prolonging survival and improving quality of life and the treatment effectiveness.