紫杉醇联合卡铂方案与联合替吉奥方案新辅助同步放化疗治疗Ⅲ期胃食管结合部癌的疗效比较

The comparison of therapeutic effects of the neoadjuvant chemoradiotherapy in stageⅢgastroesophageal adenocarcinoma(paclitaxel and carboplatin/paclitaxel and S1)

目的:评价紫杉醇联合卡铂单周方案同步放化疗在Ⅲ期胃食管结合部癌中的近期疗效和安全性,以探索Ⅲ期胃食管结合部腺癌新辅助治疗的合理治疗方案。方法:回顾分析2014年至2017年Ⅲ期胃食管结合部腺癌40例患者,分为紫杉醇卡铂单周方案联合同步放化疗组(TP组)20例和紫杉醇替吉奥3周方案同步放化疗组(TS组)20例。比较两组间的R0切除率、淋巴结转移率、手术死亡率及术后并发症发生率;比较两组新辅助同步放化疗的不良反应、有效率以及治疗前后临床分期变化;评价紫杉醇卡铂单周方案新辅助同步放化疗的近期疗效与安全性。结果:统计分析显示,临床TNM分期、分化程度、脉管癌栓、R0切除率、手术方式、并发症发生率比较无统计学差异(P>0.05);阳性淋巴结数目和清扫淋巴结数量间有统计学差异(P<0.05),TS组均较多。两组间放化疗不良反应、血液学毒性、红细胞、血小板、转氨酶比较无统计学差异(P>0.05);白细胞毒性反应,两组间有差异(P<0.05),TS组Ⅲ-Ⅳ度不良反应较多;非血液毒性,两组间比较无统计学差异(P>0.05)。术后病理分期降期比较,明显降期患者所占比例,TP组(18例)优于TS组(12例)(P<0.05)。结论:紫杉醇联合卡铂单周方案同步放化疗与紫杉醇联合替吉奥3周方案同步放化疗比较,患者不良反应小,耐受性好,降期率高,可以作为胃食管结合部癌的优选治疗方案,值得推广。

Objective:To evaluate the short-term effects and safety of neoadjuvant chemoradiotherapy(paclitaxel and carboplatin once a week)in stageⅢgastroesophageal adenocarcinoma,to explore the appropriate therapeutic method for stageⅢgastroesophageal adenocarcinoma.Methods:The 40 cases from 2014 to 2017 with stageⅢgastroesophageal adenocarcinoma were retrospectively reviewed.The patients were assigned into two neoadjuvant chemoradiotherapy groups:20 cases in paclitaxel and carboplatin one week group(TP)and 20 cases in paclitaxel and S1 three weeks group(TS).The R0 resection rate,lymph node metastasis rate,operative mortality,postoperative complications,side effects,effective rate,clinical stage before and after treatment of two groups were compared.The short-term effects and safety of neoadjuvant chemoradiotherapy(TP)in stageⅢgastroesophageal adenocarcinoma were evaluted.Results:There were no significant differences in clinical TNM staging,differentiation degree,vascular tumor thrombus,R0 resection rate,operation methods,and postoperative complications between the two groups(P>0.05).There were significant differences in the number of positive lymph nodes and lymph node dissection between the two groups(P<0.05),the TP group had more number.There were no significant differences in hematologic toxicities such as red blood cell,platelet and transaminase between the two groups of adverse reactions after chemoradiotherapy.There were significant differences in the leukocyte toxic reaction between the two groups(P<0.05).The TS group had more adverse reactions of stepⅢ-Ⅳ.There were no significant differences in non-hematologic toxicity between the two groups(P>0.05).There was more advantage in tumor down staging of TP group(n=18)than TS group(n=12)(P<0.05).Conclusion:The comparison between paclitaxel and carboplatin one week group(TP)and paclitaxel and S1 three weeks group(TS),showed it was worth developing for the TP neoadjuvant chemoradiotherapy therapy of gastroesophageal adenocarcinoma had little toxic reaction,well tolerated and high descending rate.