沙利度胺联合同步放化疗治疗老年食管癌的临床观察

Clinical observation of thalidomide combined with concurrent chemoradiotherapy in elderly patients with esophageal carcinoma

目的观察沙利度胺对行同步放化疗的老年食管癌病人的近期疗效及放化疗相关不良反应的影响。方法选择2018年6月至2021年2月于泉州市第一医院就诊的老年食管癌病人100例,随机平均分为对照组和试验组。2组均采用调强放疗及相同的化疗方案:紫杉醇135 mg/m^(2),第1天;顺铂25 mg/m^(2),第1~3天,每3周1次,共2个周期。试验组在放疗开始至放疗结束给予沙利度胺100 mg睡前口服。比较2组疗效及相关不良反应发生情况。结果试验组与对照组的客观有效率、疾病控制率差异无统计学意义(92%比90%、98%比96%,P均>0.05)。试验组恶心或呕吐、肌肉关节酸痛发生率均显著低于对照组(P<0.05)。2组白细胞减少、血小板减少、血红蛋白减少、肝功能异常、周围神经毒性发生率差异均无统计学意义(P>0.05)。试验组Ⅰ~Ⅱ级、Ⅲ~Ⅳ级放射性食管炎发生率均低于对照组(P<0.05)。结论沙利度胺可明显减轻同步放化疗过程中放射性食管炎、恶心、呕吐、肌肉关节酸痛的发生率。

Objective To observe the effect of thalidomide on the short-term effect and therapy-related adverse reactions in the elderly patients with esophageal carcinoma treated with concurrent chemoradiotherapy.Methods A total of 100 elderly patients with esophageal carcinoma treated in Quanzhou First Hospital from June 2018 to February 2021 were randomly divided into the control group and the experimental group.Both groups were treated with IMRT(intensity modulated radiotherapy)and the same chemotherapy protocol:Paclitaxel 135 mg/m^(2),day 1;Cisplatin,25 mg/m^(2),day 1-3,once every three weeks for two cycles.The experimental group was given 100 mg of thalidomide orally before bedtime from the beginning to the end of radiotherapy.The efficacy and related adverse reactions were compared between the two groups.Results There were no significant differences in objective effective rate and disease control rate between the two groups(92%vs 90%,98%vs 96%;P>0.05).The incidence rates of nausea,vomiting,and muscle and joint pain in the experimental group were significantly lower than those in the control group(P<0.05).There were no significant differences in the incidence rates of leukopenia,thrombocytopenia,decreased hemoglobin,abnormal liver function and peripheral neurotoxicity between the two groups(P>0.05).The incidence rates of radiation esophagitis of gradeⅠ-ⅡandⅢ-Ⅳin the experimental group were lower than those in the control group(P<0.05).Conclusions Thalidomide can significantly reduce the incidence of radiation esophagitis,nausea,vomiting,and muscle and joint pain during concurrent chemoradiotherapy.