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目的:探讨局部晚期贲门癌同步化、放疗的疗效和不良反应。方法:对32例局部晚期贲门癌采用直线加速器放疗,大野前后对穿照射至40 Gy,对残存病灶缩野照射至60 Gy,放疗同时以亚叶酸钙200 mg/d+5-氟尿嘧啶500 mg/d,持续4 h静脉滴注,5次/周,隔周应用;同步化放疗结束后再以顺铂+5-氟尿嘧啶的DF方案连续化疗4个周期。结果:32例患者均完成治疗,其中完全缓解4例(12.5%)、部分缓解22例(68.8%)、无变化5例(15.6%)、疾病进展1例(3.1%),总有效率81.3%;患者1,3年生存率分别为78.1%、18.8%;放、化疗期间Ⅱ~Ⅲ级不良反应如恶心、呕吐及白细胞下降反应发生率分别为46.9%和53.1%,Ⅰ级放射性食管炎发生率46.9%。结论:对失去手术机会的局部晚期贲门癌患者,基于5-氟尿嘧啶的同步化、放疗方案可有效提高患者治愈率、生存率,且不良反应可良好耐受。
Objective: To investigate the curative effect and adverse reactions of local advanced cardia cancer synchronizing and radiotherapy. Methods: Thirty-two patients with locally advanced cardiac cancer underwent linear accelerator radiotherapy. Radiation was given to 40 Gy before and after Ono, and 60 Gy was irradiated to the lesion. The radiotherapy was performed simultaneously with leucovorin 200 mg / d and 5-fluorouracil 500 mg / d, continuous 4 h intravenous drip, 5 times / week, every other week; after the end of synchronized radiotherapy cisplatin + 5 - fluorouracil DF regimen for 4 cycles of continuous chemotherapy. Results: Thirty-two patients completed complete remission (4 cases, 12.5%), partial remission in 22 cases (68.8%), no change in 5 cases (15.6%) and disease progression in 1 case (3.1%), with a total effective rate of 81.3 %. The 1-year and 3-year survival rates were 78.1% and 18.8% respectively. The incidence of grade Ⅱ-Ⅲ adverse reactions such as nausea, vomiting and leukopenia during radiotherapy and chemotherapy were 46.9% and 53.1% respectively. Grade Ⅰ radiation esophagitis The incidence of 46.9%. Conclusion: For patients with locally advanced cardia cancer who have lost the chance of surgery, the 5-fluorouracil-based synchronization and radiotherapy regimen can effectively improve the cure rate and survival rate of patients with well-tolerated adverse reactions.