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目的探讨放化疗联合与单独化疗对晚期食管癌生存期和疾病进展时间的影响,观察紫杉醇联合顺铂治疗晚期食管癌的近期疗效和不良反应。方法47例晚期和术后转移复发的食管鳞癌患者,应用紫杉醇175 mg/m2静脉点滴,d1;DDP 75 mg/m2静脉点滴,d1;21 d为1个周期。每2个周期评价疗效,将获得CR、PR和SD的患者非随机的分成可测量病灶的放射治疗组(A组)和继续化疗或观察组(B组)。结果入组的47例患者均可评价疗效,其中CR 1例,PR 19例,SD 24例, PD 3例,总有效率(CR+PR)为42.6%(95%CI为0.28～0.58)。A组21例行放疗,中位疾病进展时间(TTP)为10个月,中位生存期为13个月;B组23例行化疗或未再治疗,其中位TTP为5个月,中位生存期11个月,两组差异均有统计学意义(P<0.015,P<0.024)。化疗最常见的不良反应为脱发和骨髓抑制,无Ⅲ度以上不良反应和化疗相关死亡。放疗的不良反应主要为轻度骨髓抑制和乏力,但无中途停止和放疗相关死亡。结论紫杉醇联合DDP化疗后再放疗较单独化疗可延长晚期食管癌患者的生存时间,耐受性好,值得临床深入探讨。
Objective To investigate the effects of chemoradiotherapy combined with chemotherapy alone on survival and disease progression of advanced esophageal cancer and to observe the short-term efficacy and side effects of paclitaxel plus cisplatin in the treatment of advanced esophageal cancer. Methods Forty-seven patients with esophageal squamous cell carcinoma who had advanced stage and postoperative metastasis and recurrence were treated with paclitaxel 175 mg / m 2 intravenously, d 1; DDP 75 mg / m 2 intravenously, d 1; 21 d for 1 cycle. Efficacy was evaluated every 2 cycles. Patients receiving CR, PR, and SD were randomized to radiotherapy (group A) with measurable disease and to chemotherapy or observation (group B). Results Among the 47 patients enrolled in the study, there were 1 case of CR, 19 cases of PR, 24 cases of SD and 3 cases of PD. The total effective rate (CR + PR) was 42.6% (95% CI 0.28-0.58). In group A, 21 patients underwent radiotherapy. The median time to progression (TTP) was 10 months and the median survival time was 13 months. In group B, 23 patients underwent chemotherapy or no further treatment, with a median TTP of 5 months and a median of Survival of 11 months, the difference between the two groups were statistically significant (P <0.015, P <0.024). The most common adverse reactions of chemotherapy were alopecia and myelosuppression, with no third degree or more adverse effects and chemotherapy-related deaths. Adverse reactions to radiotherapy were mainly mild myelosuppression and fatigue, but no stopping and radiotherapy-related deaths. Conclusions The combination of paclitaxel plus DDP chemotherapy and radiotherapy alone can prolong the survival time of patients with advanced esophageal cancer and is well tolerated. It deserves clinical study.