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目的:观察“序贯夹心式”化、放疗治疗进展期食管癌的近期疗效、不良反应、生存期及年复发率。方法:采用“静脉化疗2周期局部放疗静脉化疗2周期”的序贯夹心式方法。静脉化疗运用PFL方案,顺铂(PDD)25mg/m2,d1~d3;亚叶酸钙(LV)120mg/m2,d1~d5;氟尿嘧啶(5Fu)500mg/m2,d1~d5,均静脉滴注,21天为1周期。放疗运用外照射,每次2Gy,每周5次,共30~35次,总照射剂量60~70Gy。每周期化疗前及全程治疗结束后2个月内行食管钡剂造影、CT及腹部超等检查,随访时间为5年。结果:近期总有效率83.6%;1年生存率71.4%,3年生存率44.9%,5年生存率32.7%,中位生存期18.9月。不良反应主要表现在胃肠道反应与骨髓抑制。胃肠道反应有轻度至中度的恶心、食欲下降、呕吐;骨髓抑制常见为白细胞总数下降,但多为Ⅱ~Ⅲ度,红细胞、血小板减少不常见。结论:“序贯夹心式”化、放疗治疗进展期食管癌较单一治疗方法有明显的优势,且真正体现了食管癌综合治疗的内涵和全身、局部治疗有机结合的价值,值得临床广泛应用。
OBJECTIVE: To observe the short-term curative effect, adverse reactions, survival and annual recurrence rate of “sequential sandwich” chemotherapy and radiotherapy for advanced esophageal cancer. Methods: The sequential sandwich method was adopted in “2 cycles of intravenous chemotherapy partial radiotherapy vein chemotherapy 2 cycles”. Intravenous chemotherapy using PFL regimen, cisplatin (PDD) 25mg / m2, d1 ~ d3; leucovorin (LV) 120mg / m2, d1 ~ d5; 5Fu 500mg / m2, d1 ~ d5, 21 days for 1 cycle. Radiotherapy use of external radiation, each 2Gy, 5 times a week, a total of 30 to 35 times, the total dose of 60 ~ 70Gy. Perioperative chemotherapy and barium esophagectomy, CT and abdominal ultrasonography were performed within 2 months before and after the whole course of chemotherapy. The follow-up time was 5 years. Results: The total effective rate was 83.6%. The 1-year survival rate was 71.4%, the 3-year survival rate was 44.9%, the 5-year survival rate was 32.7%, and the median survival time was 18.9 months. Adverse reactions mainly manifested in gastrointestinal reactions and bone marrow suppression. Gastrointestinal reactions mild to moderate nausea, loss of appetite, vomiting; myelosuppression common white blood cell count decreased, but mostly Ⅱ to Ⅲ degrees, red blood cells, thrombocytopenia is not common. Conclusion: “Sequential sandwich” chemotherapy and radiotherapy for advanced esophageal cancer have obvious advantages over single therapy, and truly reflect the connotation of integrated treatment of esophageal cancer and the value of systemic and local treatment. It deserves clinical application.