三维适形放疗联合卡培他滨同步化疗治疗老年食管癌疗效观察

Observation of the curative effect of the treatment of elderly esohageal cancer by three dimensional conformal radiotherapy combined with capecitabine synchronous chemotherapy

目的老年食管癌患者手术死亡率高,同步放化疗已成为标准治疗方案。本研究比较卡培他滨联合三维适形放疗和单纯放疗治疗老年食管癌的疗效和不良反应。方法回顾性分析山东省千佛山医院放疗科2010-01-01-2013-09-30收治的86例老年食管癌患者临床资料,按治疗方法分为放化疗组(45例)和单纯放疗组(41例)。两组均采用三维适形放疗技术,采用6 MV直线加速器常规分割,设同中心照射3~7个,全程三维适形放疗。1.8Gy/次,5次/周,放疗1个月。放化疗组在放疗第1天开始口服卡培他滨,2次/d,每次850mg/m2,与放疗同步,连用2周后休息1周。结果放化疗组和单纯放疗组放疗结束时完全缓解效率分别为30.61%和14.63%,两组比较差异有统计学意义,P<0.05。放化疗组3年生存率为37.2%,放疗组三年生存率为17.5%,差异有统计学意义,P<0.05。两组主要毒副作用分别为3~4级食管炎(放化疗组11例,单纯放疗组8例)和2~4级白细胞减少(放化疗组26例,单纯放疗组20例),患者均可耐受。结论卡培他滨联合三维适形放疗可提高老年食管癌疗效,放化疗组患者3年生存率明显高于化疗组,无严重不良反应。值得进一步推广应用。

OBJECTIVE Because of the high mortality in surgical treatment of elderly patients with esophageal cancer,concurrent chemoradiotherapy has become the standard treatment. This study compared the efficacy and adverse reactions of the treatment on elderly patients with esophageal cancer by the three dimensional conformal radiotherapy corn bined with capecitabine chemotherapy with that by radiotherapy alone. METHODS By using the random number table, 86 cases of esophageal cancer patients, who were admitted by Department of Radiotherapy in Qianfoshan Hospital of Shandong between 2010-01-01 and 2013-09-30,were divided into radiotherapy combined with Shiroda synchronous chemo therapy group（45 cases） and radiotherapy group（41 cases）. The three dimensional conformal radiotherapy was used in the two groups, 6MV linear accelerator conventional segmentation and same center radiation 3- 7, 1. 8 Gy each time and 5 times per week for a month. The radiotherapy and chemotherapy group started oral capecitabine in radiotherapy first day,850 mg/（m2 · d） each time,2 times per day for 2 weeks and then stopping for 1 week. RESULTS When the radio- therapy treatment was completed the remission rate of the radiotherapy and chemotherapy group was 30.61 % and control group 14.63%. The difference between 2 groups has statistical significance,P〈 0.05. The main toxic and side effects of the two groups were esophagitis from grade 3 to grade 4 （11 and 8 cases） and white blood cell reduction from grade 2 to grade 4 （26 and 20 cases） which patients can tolerate. CONCLUSIONS The three dimensional conformal radiotherapy combined with capecitabine chemotherapy can improve the curative effect of esophageal cancer of elderly patients. The 3 year survival rate of the radiotherapy and chemotherapy group was significantly higher than that of the chemotherapy only group. The adverse reaction is not serious. It is worthy of further spread and generalization.