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目的观察新辅助放化疗联合手术治疗局部晚期食管癌的疗效和安全性。方法将70例局部晚期食管癌患者随机分为观察组(新辅助放化疗联合手术组)35例和对照组(单纯手术组)35例。观察组新辅助放化疗方案:周剂量多西他赛联合顺铂化疗2个周期,同期采用常规分割放疗2.0Gy/d,每周5d,总量40Gy;化疗结束4-6周后行手术治疗。对照组患者直接接受手术治疗。术后两组治疗相同。结果观察组完全缓解4例,部分缓解27例,稳定3例,病情进展1例,临床有效率88.6%。两组均顺利完成手术,观察组的R0切除率高于对照组(97.1%vs.82.9%)(P<0.05)。观察组的1、2年生存率与对照组相比无统计学差异(82.9%、74.3%vs.77.1%、68.6%),3年生存率高于对照组(65.7%vs.51.4%)。观察组的1、2年无瘤生存率与对照组相比无统计学差异(80.0%、71.4%vs.74.3%、65.7%),3年无瘤生存率高于对照组(62.9%vs.48.6%)(P<0.05)。结论新辅助放化疗联合手术治疗局部晚期食管癌,安全性高,可明显提高R0切除率,降低食管癌的术后病理分期,并提高3年生存率和3年无瘤生存率。
Objective To observe the efficacy and safety of neoadjuvant chemoradiation combined with surgery in the treatment of locally advanced esophageal cancer. Methods Seventy patients with locally advanced esophageal cancer were randomly divided into observation group (neoadjuvant chemoradiation and surgery group) 35 cases and control group (surgery group 35 cases). Neoadjuvant radiotherapy and chemotherapy regimen: Week dose of docetaxel combined with cisplatin chemotherapy 2 cycles, the same period with conventional fractionated radiotherapy 2.0Gy / d, 5d week, the total 40Gy; 4-6 weeks after the end of chemotherapy surgery. Patients in the control group received surgery directly. After treatment, the same two groups. Results In the observation group, 4 cases were completely relieved, 27 cases were partly relieved, 3 cases were stable, 1 case was progressed. The clinical effective rate was 88.6%. Surgery was successfully performed in both groups, and R0 resection rate in the observation group was higher than that in the control group (97.1% vs.82.9%, P <0.05). The 1-year and 2-year survival rates in the observation group were not significantly different from those in the control group (82.9%, 74.3% vs 77.1%, 68.6%). The 3-year survival rate was significantly higher in the observation group than in the control group (65.7% vs. 51.4%). The 1 and 2 year disease-free survival rates in the observation group were not significantly different from those in the control group (80.0%, 71.4% vs 74.4%, 65.7%). The 3-year disease-free survival rate was significantly higher in the observation group than in the control group (62.9% vs. 48.6%) (P <0.05). Conclusions Neoadjuvant chemoradiation combined with surgery for locally advanced esophageal cancer is safe and can significantly improve the R0 resection rate and reduce the postoperative pathological stage of esophageal cancer, and improve the 3-year survival rate and 3-year disease-free survival rate.