后程加速超分割放射治疗加同步化疗治疗食管癌

Late course accelerated hyperfractionation combined with synchronizing chemotherapy for esophageal carcino- ma

目的 :探讨食管癌后程加速超分割放射治疗加顺铂、氟尿嘧啶同步化疗的疗效和毒性 .方法 :95例食管癌患者随机分成后程加速超分割放射治疗加顺铂、氟尿嘧啶同步化疗组 (综合组 )和后程加速超分割放射治疗组 (后超组 ) .后超组 (4 7例 )前 2 / 3疗程为常规分割 (2Gy/次 ,5次·wk-1 )照射 36～ 4 0Gy后缩野改加速超分割 (1 .5Gy/次 ,2 次·d-1 )照射 2 7～ 30Gy .综合组 (4 8例 )在后超组的基础上静脉内输注顺铂 2 0mg·d-1 ,氟尿嘧啶 5 0 0mg·d-1 ,连用 5d为 1周期 .分别在第 1 ,4周实施 ,共 2个周期 .结果 :1 ,2和 3a生存率 ,综合组分别为 83.3% ,6 4 .6 %和 5 6 .3% ,后超组分别为76 .5 % ,5 1 .1 %和 34.0 % (χ2 =4 .1 6 4 ,P =0 .0 4 1 3) .1 ,2和 3a局部控制率 ,综合组分别为 87.5 % ,77.1 %和 6 6 .7% ;后超组分别为 80 .9% ,6 1 .7%和 4 2 .5 % (χ2 =5 .4 1 9,P =0 .0 2 0 ) .综合组Ⅰ～Ⅲ度急性放射性气管炎发生率分别为 2 0 .8% ,1 2 .5 % ,4 .2 % ;后超组分别为 1 9.2 % ,1 0 .6 % ,2 .1 % ,两组差异无显著性意义 (χ2 =0 .2 0 6 ,P >0 .0 5 ) .综合组Ⅰ～Ⅳ度急性放射性食管炎的发生率分别为 2 9.2 % ,35 .4 % ,8.3%和 2 .1 % ;后超组分别为 2 5 .5 % ,31 .9% ,6 .4 %和 0 .两组差异无显著?

AIM: To investigate the efficiency and side effect of the hyperfractionation combined with Cisplatin and Fluorouracil on the treatment of carcinoma of esophagus. METHODS: Of 95 cases with carcinoma of esophagus, 48 cases were randomized into hyperfractionation combined with Cisplatin and Fluorouracil chemotherapy group (HCC), and 47 cases in hyperfractionation group (HF). All patients in HF group were treated with conventional fractionation regimen during the first two thirds of the course with total dose 36-40 Gy (2 Gy/f, 5 fractions·wk -1 ), and followed by late course accelerated hyperfractionation with reduced fields (LCAH), with dose of 27-30 Gy (1.5 Gy/f, twice daily). Patients in HCC group, in addition to LCAH, intravenous infusion of Cisplatin 20 mg·d -1 , and Fluorouracil 500 mg·d -1 , were given for five consecutive days respectively in week 1 and week 4. RESULTS: The 1, 2 and 3 year actual survival rate were 83.3%, 64.6%, and 56.3% respectively in HCC. Corresponding, 76.5%, 51.1%, and 34.0% respectively in HF group ( χ 2=4.164, P =0.0413). Local control in HCC group in year 1, 2, 3 were 87.5%, 77.1% and 66.7%; Corresponding, 80.9%, 61.7% and 42.5% in HF respectively ( χ 2=5.419, P =0.020). No significant differences in incidences of acute tracheobronchitis and acute radioactive esophagitis between HCC and HF groups were found ( P >0.05), however, acute response of hematopoietic system in HCC group was more that that in HF group ( χ 2=4.878, P <0.05). CONCLUSION: The treatment effect on CE with HCC is superior to that with HF.