三维适形放疗联合多西他赛周剂量同步化疗治疗中晚期食管癌的近期疗效及远期预后生存分析

Analysis on Short-Term Effect and Long-Term Prognosis of Three-Dimensional Conformal Radiotherapy plus a Week Dose of Docetaxel on Advanced Esophageal Cancer

目的探讨三维适形放疗(3DCRT)联合多西他赛(DOC)周剂量同步化疗治疗中晚期食管癌的近期疗效及远期预后。方法选择2015年1月—2016年9月我院收治的中晚期食管癌患者80例为研究对象,采用随机数字表法分为观察组和对照组,各40例。对照组仅给予3DCRT,观察组采用3DCRT+DOC周剂量同步化疗,所有患者均治疗6周。治疗结束后采用实体瘤疗效评价标准(RECIST)对两组患者的近期疗效进行评定,并比较毒副反应的发生情况。采用电化学发光法检测两组患者治疗前、后血清肿瘤标志物[癌胚抗原(CEA)、糖类抗原19-9(CA19-9)、CA125]水平。对两组患者进行至少3年的追踪随访(直至死亡),比较总生存率、局部控制率、无远处转移生存率。结果观察组患者客观缓解率(RR)(80.00%)显著高于对照组(57.50%)(P<0.05);观察组患者疾病控制率(DCR)(92.50%)与对照组(82.50%)无明显差异(P>0.05)。观察组患者1、2、3年总生存率分别为75.00%、62.50%、42.50%,对照组分别为52.50%、40.00%、20.00%,观察组3年累积生存率显著高于对照组(P=0.014)。观察组患者1、2、3年局部控制率分别为85.00%、72.50%、65.00%,对照组为82.50%、60.00%、42.50%;两组随访1、2年的局部控制率比较,差异无统计学意义(P>0.05),但观察组3年局部控制率显著高于对照组(P<0.05)。观察组患者1、2、3年无远处转移生存率(87.50%、80.00%、75.00%)均显著高于对照组同期(65.00%、52.50%、45.00%)(P<0.05)。两组患者各项毒副反应程度比较,差异无统计学意义(P>0.05)。治疗后,两组患者血清CEA、CA19-9及CA125水平均显著低于治疗前(P<0.05),且观察组显著低于对照组同期(P<0.05)。两组患者GTV、CTV平均照射剂量无明显差异(P>0.05)。结论应用3DCRT联合DOC周剂量同步化疗治疗中晚期食管癌的近期疗效良好,患者远期生存率及无远处转移生存率较高,且安全性较好。

Objective To investigate the short-term effects and long-term prognosis of three-dimensional conformal radiotherapy(3DCRT) plus concurrent weekly docetaxel(DOC) in the treatment of advanced esophageal cancer. Methods Eighty patients with middle and advanced esophageal cancer enrolled in our hospital between January 2015 and September 2016 were divided into observation group(n=40) and control group(n=40) on the basis of random number table. The control group was treated merely with 3DCRT, while the observation group with 3DCRT plus weekly DOC simultaneously. All patients were treated for 6 weeks. After treatment, the short-term effects and side effects were evaluated and compared. Besides, the serum tumor markers [carcino-embryonic antigen(CEA), carbohydrate antigen(CA) 19-9 and CA125] were tested via electrochemiluminescence immunoassay before and after treatment. All patients got a follow-up which lasted for at least 3 years(until death comes). The overall survival rate, local control rate and distant metastasis-free survival rate were compared between the two groups. Results The objective remission rate(RR) of the observation group was 80.00%(32/40), much higher than 57.5%(23/40) of the control group(P<0.05). The two groups had no statistical differences in disease control rate(DCR) [observation group(92.50%) vs. control group(82.5%)](P>0.05). The 1-, 2-and 3-year overall survival rates of the observation group were 75.00%, 62.50% and 42.50% respectively, and those of the control group were 52.50%, 40.00% and 20.00% respectively. The 3-year cumulative survival rate of the observation group was higher than that of the control group(P=0.014). The 1-, 2-and 3-year local control rates were respectively 85.00%, 72.50% and 65.00% in the observation group, but were respectively 82.50%, 60.00% and 42.50% in the control group. There were no statistical differences in 1-and 2-year local control rates between the two groups(P>0.05), but the observation group had significantly higher 3-year local control rate than the control group(P<0.05). The observation group also had obviously higher distant metastasisfree survival rates at the 1st, 2nd and 3rd year follow-up(respectively 87.50%, 80.00% and 75.00%) than the control group(respectively 65.00%, 52.50% and 45.00%)(P<0.05). No statistical differences were observed in the degree of side effects between the two groups(P>0.05). After treatment, both groups saw a great drop in CEA, CA19-9 and CA125 levels as compared with those before treatment(P<0.05), and the observation group witnessed much lower levels of aforementioned tumor markers than the control group did(P<0.05). There was no significant difference in the average dose of GTV and CTV between the two groups(P>0.05). Conclusion The application of 3DCRT combined with weekly DOC concurrent chemotherapy had a good short-term effect in the treatment of middle and advanced esophageal cancer. It achieved a good long-term survival rate and distant metastasis-free survival rate, and it was safe for patients.