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目的探讨进展期食管胃交界腺癌术后调强放疗联合同期化疗的临床疗效和不良反应。方法进展期食管胃交界腺癌根治术后患者68例,随机分为对照组和观察组各34例,对照组接受DS方案(Docetaxel 35mg/m2,静脉注射d1,d8;S-1 70mg/(m2.d),2次/d,餐后口服,d1～14,每3周重复)化疗,全部患者接受4～6周期化疗;观察组在对照组的基础上实施序贯调强放疗:每日180cGy,每周5次,总剂量50～55Gy。分析比较二组的1年生存率及1年无疾病进展生存率,同时评价治疗期间的不良反应。结果对照组和观察组1年生存率分别为71.6%和88.2%,二组比较差异无统计学意义(P=0.069);1年无疾病进展生存率分别为34.4%和76.2%,差异有统计学意义(P=0.015)。主要不良反应有骨髓抑制、口炎、手足综合征及胃肠道不良反应,多以Ⅰ～Ⅱ度为主,Ⅲ～Ⅳ度发生率低,均可耐受。二组比较差异均无统计学意义(P>0.05)。结论进展期食管胃交界腺癌术后调强放疗联合同期DS方案化疗与单纯化疗相比,能提高术后1年无疾病进展生存率,急性毒副反应可以耐受,值得临床进一步多中心对照研究及推广应用。
Objective To investigate the clinical efficacy and adverse reactions of postoperative IMRT combined with concurrent chemotherapy in patients with advanced esophageal and gastric cancer. Methods Sixty-eight patients with advanced adenocarcinoma after esophageal-gastric junctional resection were randomly divided into control group and observation group with 34 cases each. Patients in control group received Docetaxel 35 mg / m2 intravenously for d1 and d8; S-1 70 mg / ( m2.d), 2 times / d, postprandial oral, d1 ~ 14, repeated every 3 weeks) chemotherapy, all patients received 4 to 6 cycles of chemotherapy; the observation group in the control group based on sequential intensity modulated radiotherapy: Day 180cGy, 5 times a week, the total dose of 50 ~ 55Gy. The 1-year survival rate and 1-year disease-free survival rate of the two groups were compared and analyzed. The adverse reactions during the treatment period were also evaluated. Results The 1-year survival rates of the control group and the observation group were 71.6% and 88.2% respectively, with no significant difference between the two groups (P = 0.069). The 1-year progression-free survival rates were 34.4% and 76.2% respectively, with statistical differences Significance of learning (P = 0.015). The main adverse reactions were myelosuppression, stomatitis, hand-foot syndrome and gastrointestinal adverse reactions, mostly in grade I ~ II, Ⅲ ~ Ⅳ degree of low incidence, are tolerable. There was no significant difference between the two groups (P> 0.05). Conclusions The postoperative IMRT combined with DS regimen chemotherapy in advanced esophageal and gastric adenocarcinoma can improve the disease-free survival rate at 1 year after operation, and the acute toxicities and side effects can be tolerated. It is worthy of clinical further multicenter control Research and popularization and application