同期放化疗治疗Ⅰ-Ⅱ期食管鳞癌

Clinical effect of concurrent chemoradiotherapy forⅠ-Ⅱ period of esophageal squamous cell carcinomas

目的:探讨三维适形放疗联合紫杉醇+顺铂（TP方案）治疗Ⅰ-Ⅱ期食管鳞癌的临床效果。方法:选取2010年9月至2012年3月住院治疗的63例Ⅰ-Ⅱ期食管鳞癌患者,分为三维适形放疗联合TP方案同期化疗组(紫杉醇120mg d1,8,顺铂3040mg d24)（A组:34例）及单纯三维适形治疗组（B组:29例）;三维适形治疗给予60Gy/30次。对患者近期疗效、生存时间、不良反应及生活质量进行随访。结果:同期放化疗组（A组）共有32例完成治疗,其中完全缓解21例（65.62%）,1、2、3年生存率分别为93.75%、7 5.0%、5 6.2 5%,1年无复发生存率为78.04%;单纯三维适形组（B组）共有27例完成治疗,其中完全缓解17例（62.96%）,1、2、3年生存率为85.18%、62.96%、37.03%;1年无复发生存率为66.67%。两组患者的生活质量评分（QOL）量表评分比较,治疗前两组无统计学差异,治疗后A组明显提升,差异具有统计学意义（P<0.05）。A组患者的中位无进展生存期（PFS）为34个月,B组患者的中位PFS为25个月,差异具有统计学意义（P<0.05）。结论:同期放化疗治疗Ⅰ-Ⅱ期食管鳞癌患者可以提高近期疗效和中位PFS时间,且不良反应可耐受,值得进一步探讨研究。

Objective: To discuss the clinical effects of three dimensional conformal radiotherapy combined therapy with paclitaxel plus cisplatin( TP) to Ⅰ- Ⅱ period of esophageal cell carcinomas( ESCC). Methods: To select 63 Ⅰ- Ⅱ period esophageal cancer patients divide them into groups,use three- dimensional conformal radiotherapy combined TP scheme with synchronous chemotherapy( 120 mg of paclitaxel d_(1,8),cisplatin 30 ~ 40 mg d_(2 ~ 4))( 34 cases),and three- dimensional conformal radiation therapy( 29 cases),using 60 Gy /30 times. And follow- up of the patients' survival rate,adverse reaction and quality of life. Results: 32 cases in concurrent chemoradiotherapy group( group A)had complete treatment,the effective rate was 100%,including 21( 65. 62%) complete remission. Survival rates of 1year,2 years and 3 years are 93. 75%,75. 0%,56. 25%. 1 year relapse- free survival rate was 78. 04%. 27 cases had complete treatment with three- dimensional conformal radiotherapy( group B),which the effective rate was100%,including 17( 62. 96%) complete remission. Survival rates of 1 year,2 years and 3 years were 85. 18%,62. 96%,37. 03%. 1 year relapse- free survival rate was 66. 67%. Compare the score of quality of life( QOL),before treatment,there was no significant difference and after treatment the score of group A improved which was statistically significant( P < 0. 05). Median survival time of group A was 34 months and in group B it was 25 months. The difference was statistically significant( P < 0. 05). Conclusion: Concurrent chemotherapy and radiotherapy in Ⅰ- Ⅱ esophageal cancer treatment can improve efficacy and patients' survival time,and adverse reactions can be tolerated.