单纯放疗和同期放化疗治疗食管癌的疗效及不良反应

Therapeutic effects and adverse reactions of simple radiotherapy and concurrent chemoradiotherapyon esophageal cancer

目的探讨比较单纯放疗和同期放化疗治疗食管癌的临床疗效及不良反应。方法选择2015年6月年2017年10月威海市中心医院收治的食管癌患者120例，根据治疗方案分为对照组60例和观察组60例。对照组采用单纯放疗治疗，观察组采用同期放化疗治疗，两组均连续治疗2个周期，治疗结束后对患者的疗效进行评估。记录并统计两组治疗后2个周期的近期有效率；采用流式细胞仪测定两组治疗前后CD3＋、CD4＋、CD8＋、CD4＋/CD8＋水平；根据常见不良反应事件评价标准（NCI-CTCAE4.0）评估两组患者治疗后不良反应发生率；两组治疗后随访5年，记录并统计患者治疗后生存率及中位生存期，比较两组临床疗效及不良反应发生情况。结果观察组采用同期放化疗治疗2个周期的有效率为51.67%，高于对照组的36.67%（P〈0.05）；观察组与对照组治疗后2个周期CD3＋、CD4＋及CD4＋/CD8＋水平均高于治疗前（P均〈0.05）；观察组与对照组治疗后2个周期CD8＋水平低于治疗前（P〈0.05）；观察组治疗后2个周期CD3＋、CD4＋及CD4＋/CD8＋水平均高于对照组（P均〈0.05）；观察组治疗后2个周期CD8＋水平低于对照组（P〈0.05）；观察组与对照组治疗后2个周期恶心呕吐、白细胞下降、腹泻、发热、神经毒性及皮疹等不良反应发生率比较差异未见统计学意义（P〉0.05）；观察组治疗后1、3、5年远期有效率均高于对照组（P均〈0.05）。对两组患者均进行连续5年的随访，观察组无病生存率高于对照组（P〈0.05）。结论食管癌患者采用同期放化疗治疗疗效优于单纯放疗，有助于提高近期疗效和生存率，改善患者免疫水平，且不增加不良反应发生率，值得临床推广应用。

Objective To investigate the clinical efficacy and adverse reactions of simple radio- therapy and concurrent chemoradiotherapy in patients with esophageal cancer. Methods A total of 120 patients with esophageal cancer admitted in Weihai Central Hospital from June 2015 to October 2017 were selected and were divided into control group （60 cases） and observation group （60 cases） according to the treatment protocols. Patients in control group were treated by radiotherapy alone, and patients in ob- servation group were treated by concurrent radiotherapy and chemotherapy treatment, two groups were both treated for 2 courses. After treatment, the curative effect was evaluated. The short-term curative effect of two groups after treatment was recorded and compared. The levels of CD3 ＋ , CD4 ＋ , CD8 ＋ and CD4 ＋/CD8 ＋ before and after treatment were measured by flow cytometry. The incidence of ad- verse reactions was evaluated. The patients were followed up for 5 years after treatment to record the sur- vival rate and median survival time. The clinical efficacy and the incidence of adverse reactions were compared between the two groups. Results The effective rate of observation group was 51.67%, which was higher than that of control group （36. 67% ） , P 〈0. 05. After 2 courses of treatment, the levels of CD3 ＋, CD4 ＋ and CD4 ＋/CD8 ＋ of the two groups were higher than those before treatment （ all P 〈 0.05 ）, and the levels of CD8 ＋ in the two groups were lower than those before treatment （ P 〈 0. 05 ）. The levels of CD3 ＋ , CD4 ＋ and CD4 ＋/CD8 ＋ in observation group were higher than those in control group after 2 courses of treatment （ all P 〈 0. 05 ）. After 2 courses of treatment, the level of CD8 ＋ inobservation groups was lower than that in control group （ P 〈 0.05 ）. There was no significant difference in incidence of adverse reactions, such as nausea and vomiting, leukopenia, diarrhea, fever, neurotoxic- ity and rash toxicity, between observation group and control group （P 〉 0. 05）. The long-term curative effects at 1, 3 and 5 years after treatment in observation group were higher than those in control group （ all P 〈 0. 05）. The two groups were followed up for 5 years continuously, and the disease free survival rate in observation group was higher than that in control group （P 〈 0. 05 ）. Conclusions Concurrent chemoradiotherapy is superior to radiotherapy alone for esophageal cancer patients, which can help to im- prove the short-term curative effect, survival rate and immunity level without increasing the incidence of adverse reactions, it is worth popularizing and applying.