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目的探讨奈达铂(NDB)联合三维适形放射(3DCRT)方法治疗晚期食管癌的近期疗效、生存期及毒性反应。方法90例食管癌病人根据入选标准,随机分组,46例进入3DCRT+NDB组(试验组),44例进入单纯3DCRT组(对照组)。NDB按80～100 mg·m~(-2)+氯化钠注射液500 mL静脉滴注2h, d1,28d为一个周期,共行3个周期。先进行1个周期化疗后开始3DCRT,每次5～6 Gy,隔日照射1次,共7～8次,总剂量40～42 Gy(13～15d)。结果有效率试验组为91%,对照组为71%(P< 0.05);1、2、3年局部控制率试验组分别为76%、70%和50%,对照组分别为45%、34%和20% (P<0.05);1、2、3年生存率试验组分别为72%、59%和50%,对照组分别为41%、36%和25% (P<0.05)。试验组的白细胞下降及血小板减少发生率较对照组高(P<0.05;P<0.01),但病人均能耐受。结论以NDB单药联合3DCRT治疗能明显改善晚期食管癌生存率和局部控制率,虽不良反应增加但均能耐受。
Objective To investigate the short-term efficacy, survival and toxicity of nedaplatin (NDB) combined with three-dimensional conformal radiation (3DCRT) in the treatment of advanced esophageal cancer. Methods According to the inclusion criteria, 90 patients with esophageal cancer were randomized, 46 patients entered the 3DCRT+NDB group (test group), and 44 patients entered the simple 3DCRT group (control group). NDB was intravenously infused with 80 ~ 100 mg·m~(-2) + 500 mL of sodium chloride injection for 2 h, and d1, 28 d was a cycle for a total of 3 cycles. The first cycle of chemotherapy followed by 3DCRT, each time 5 ~ 6 Gy, irradiation once every other day, a total of 7 to 8 times, the total dose of 40 ~ 42 Gy (13 ~ 15d). Results The effective rate was 91% in the experimental group and 71% in the control group (P<0.05); the local control rate was 76%, 70%, and 50% in the 1st, 2nd, and 3rd year groups, and 45% and 34% in the control group, respectively. % and 20% (P<0.05); 1-, 2-, and 3-year survival rates were 72%, 59%, and 50% in the experimental group, and 41%, 36%, and 25% in the control group, respectively (P<0.05). The rate of leukopenia and thrombocytopenia in the experimental group was higher than that in the control group (P<0.05; P<0.01), but the patients were all able to tolerate. Conclusion Treatment with NDB alone and 3DCRT can significantly improve the survival rate and local control rate of advanced esophageal cancer. Although the adverse reactions increase, they can all tolerate.