多西紫杉醇周剂量化疗同步放疗治疗老年食管鳞癌

Weekly docetaxel chemotherapy combined with concurrent radiotherapy for elderly esophageal squamous cell carcinoma

目的比较多西紫杉醇周剂量化疗同步放疗与单纯放疗治疗老年食管鳞癌的疗效。方法选取2016年9月至2017年9月收治的老年食管鳞癌患者共80例,年龄≥70岁,随机分为研究组及对照组,各40例。对照组单纯应用调强适形放疗,肿瘤量DT:60Gy/30f,单次分割剂量:2Gy/f。研究组在对照组三维适形调强放疗基础上联合多西紫杉醇周剂量同步化疗,放疗期间予多西紫杉醇40mg/次,每周1次,共4周;对比患者临床疗效[完全缓解(CR)、部分缓解(PR)、稳定(SD)、进展(PD)]和毒副反应。结果研究组CR19例,PR15例,SD3例,PD3例;对照组CR14例,PR11例,SD9例,PD6例。研究组临床总有效率(CR+PR)为85.0%,明显高于对照组的62.5%(P<0.05)。研究组1年疾病无进展生存率80.0%明显高于对照组的55.0%(P<0.05)。同步放化疗组1~2级白细胞减少、血小板减少及放射性食管炎较单纯放疗组有所增加,但经临床处理后均顺利完成治疗。结论多西紫杉醇周剂量化疗同步放疗与单纯放疗治疗老年性食管癌,疗效较高,毒副反应能耐受,可提高患者近期生存率,远期生存是否得益尚需继续随访观察。

Objective To compare the efficacy of weekly docetaxel chemotherapy combined with concurrent radiotherapy and radiotherapy alone in the treatment of patients with esophageal squamous cell carcinoma ( ESCC ). Methods Eighty elderly patients with ESCC treated from September 2016 to September 2017 were randomly divided into study group and control group ( n = 40, each). The intensity modulated radiation therapy (IMRT) alone [ tumor volume doubling time( DT), 60 GY/30f, single fractional dose :2 GY/f] was conducted in control group, and concurrent weekly docetaxel chemotherapy (40 mg, once a week for 4 weeks) was performed during radiotherapy in study group. The clinical efficacy and toxicity were compared between two groups. Results There were 19 cases of complete response ( CR), 15 cases of partial response (PR),3 cases of stable disease(SD) and 3 cases of progressive disease(PD) in study group and 14 cases of CR, 11 cases of PR,9 cases of SD and 6 cases of PD in control group. The total clinical effective rate ( CR + PR) in study group was significantly higher than that in control group (85. 0% vs 62. 5%, P < 0. 05 ). One-year progression-free survival rate in study group was statistically higher than that in control group (80. 0% vs 55. 0%,P < 0. 05 ). Even though the incidences of grade 1-2 leukopenia, thrombocytopenia, and radiation esophagitis in study group were higher than those in control group, the treatment process was successfully completed after clinical treatment. Conclusion Weekly docetaxel chemotherapy combined with concurrent radiotherapy has higher efficacy, tolerable toxic and side effects and improve the short-term survival rate of patients in the treatment of senile esophageal cancer. Whether long-term survival benefits still need to be confirmed by further follow-up observation.