论文部分内容阅读
目的评价后程加速超分割放疗协同化疗食管癌的疗效和副反应。方法对173例食管鳞癌患者进行前瞻随机分组研究,其中后程加速超分割放疗(LCAHR)组89例,后程加速超分割放疗协同化疗(LCAHR+C)组94例。LCAFR组前2/3疗程常规分割放疗至40Gy(1.8~2.0Gy/次,1次/d,5d/周),后1/3疗程缩野后改用后程加速超分割(1.5Gy/次,2次/d,5d/周),全程总剂量60~70Gy,34~42分次,37~42d完成。LCAFR+C组在上述放疗的同时加用化疗,从放疗第1天给予LFP方案:顺铂(PDD)20mg/d,亚叶酸钙(CF)100mg/d,氟尿嘧啶(5-Fu)500mg/d,均连续静脉滴注5d,28d为1个周期,共4个周期。结果LCAHR组和LCAHR+C组近期总有效率分别为85%和95%(χ2=4.45,P=0.035);1、2、3年局部控制率分别为73%、55%、49%和83%、73%、65%(χ2=5.32,P=0.021);1、2、3年生存率分别为74%、53%、41%和84%、65%、52%(χ2=2.85,P=0.091)。LCAHR+C组白细胞减少和消化道反应均明显高于LCAHR组(χ2=7.85、15.06;P=0.005、0.000)。结论后程加速超分割放疗协同化疗可提高近期疗效和3年局部控制率,可作为食管癌较有效的治疗手段,但白细胞减少和胃肠反应毒副反应增加。
Objective To evaluate the efficacy and side effects of late course accelerated hyperfraction radiotherapy in the treatment of esophageal cancer. Methods 173 patients with esophageal squamous cell carcinoma were prospectively randomized to study. Among them, 89 patients underwent LCAHR and 94 patients underwent LCAHR + C. The first two thirds of the course of LCAFR were divided into radiotherapy of 40Gy (1.8-2.0Gy / time, once / d, 5d / week) , 2 times / d, 5d / week), the total dose of 60 ~ 70Gy, 34 ~ 42 times, 37 ~ 42d completed. In the LCAFR + C group, chemotherapy was given at the same time as radiotherapy. LFP regimen was given on the first day of radiotherapy: cisplatin (PDD) 20mg / d, leucovorin (CF) 100mg / d and fluorouracil 500mg / d , Were continuous intravenous infusion 5d, 28d for a cycle, a total of 4 cycles. Results The total effective rates of LCAHR group and LCAHR + C group were 85% and 95% respectively (χ2 = 4.45, P = 0.035). The local control rates at 1, 2 and 3 years were 73%, 55%, 49% and 83% The survival rates at 1, 2 and 3 years were 74%, 53%, 41% and 84%, 65% and 52% (χ2 = 2.85, P = 0.091). LCAHR + C group leukopenia and gastrointestinal reactions were significantly higher than the LCAHR group (χ2 = 7.85,15.06; P = 0.005,0.000). Conclusions Late course accelerated hyperfraction radiotherapy combined with chemotherapy can improve the short-term curative effect and 3-year local control rate. It can be used as an effective treatment for esophageal cancer, but the leukopenia and gastrointestinal reactions increase.