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目的探讨三维适形放射治疗同步周剂量化学治疗在中晚期食管癌治疗中的近期有效率、不良反应及生存率。方法选择80例中晚期食管癌患者,根据入选标准进入研究,其中男性52例,女性28例;年龄56～82岁,中位年龄66岁。随机分为2组,三维适形放射治疗同步周剂量TP方案化学治疗组(放化疗组)28例;单纯三维适形放射治疗组(单放组)52例。放化疗组采用三维适形放射治疗,常规分割,每次2 Gy,1次/天,5天/周,放疗剂量60～66 Gy,同步给予TP方案,组成及用法:顺铂20～30mg/m2,第1、2天和第8、9天静脉滴注;紫杉醇90 mg/m2,第1天、第8天静脉滴注;28 d为1个周期,共2～4个周期。单放组采用单纯三维适形放射治疗,放射剂量同放化疗组。结果放化疗组近期有效率为96.4%,单放组为96.2%,两组比较,差异无统计学意义(P>0.05)。放化疗组1年、2年、3年生存率分别为73.5%、68.8%、49.7%,1年、2年、3年局部控制率分别为86.8%、72.7%、60.3%;单放组1年、2年、3年生存率分别为69.5%、50.9%、35.6%,1年、2年、3年局部控制率分别为71.6%、55.4%、47.8%。两组患者1年生存率差异无统计学意义,2年、3年生存率及1年、2年、3年局部控制率差异均有统计学意义。放化疗组不良反应主要是放射性食管炎、消化道反应和血液毒性,患者均能耐受。结论三维适形放射治疗同步周剂量TP方案化学治疗对中晚期食管癌近期疗效及生存率较好,虽不良反应增加但患者可以耐受。
Objective To investigate the recent efficacy, adverse reactions and survival rates of synchronous three-dimensional conformal radiation therapy in the treatment of advanced esophageal cancer. Methods Eighty patients with advanced esophageal cancer were enrolled. According to the inclusion criteria, 52 males and 28 females were enrolled. The age ranged from 56 to 82 years, with a median age of 66 years. Randomly divided into two groups, three-dimensional conformal radiotherapy synchronized weekly dose TP regimen chemotherapy group (radiotherapy and chemotherapy group) 28 cases; simple three-dimensional conformal radiotherapy group (single radiotherapy group) 52 cases. Radiotherapy and chemotherapy group were treated with three-dimensional conformal radiotherapy and routinely divided into 2 Gy, 1 time / day, 5 days / week and radiation dose of 60-66 Gy. The TP regimen was given simultaneously. Composition and usage: Cisplatin 20-30mg / m2 on days 1 and 2 and days 8 and 9; paclitaxel 90 mg / m2 on day 1 and day 8; and 28 days for 1 cycle for 2 ~ 4 cycles. Single group using a simple three-dimensional conformal radiotherapy, radiation dose with radiotherapy and chemotherapy group. Results The effective rate of radiotherapy and chemotherapy group was 96.4% and that of radiotherapy and chemotherapy group was 96.2%. There was no significant difference between the two groups (P> 0.05). The 1-year, 2-year and 3-year survival rates of radiotherapy and chemotherapy group were 73.5%, 68.8% and 49.7%, respectively. The local control rates of one year, two years and three years were 86.8%, 72.7% and 60.3% The 2-year and 3-year survival rates were 69.5%, 50.9% and 35.6% respectively. The local control rates at 1 year, 2 years and 3 years were 71.6%, 55.4% and 47.8% respectively. There was no significant difference in one-year survival rate between two groups of patients, 2-year, 3-year survival rates and 1 year, 2 years, 3 years local control rate differences were statistically significant. Radiotherapy and chemotherapy group adverse reactions are mainly radio esophagitis, gastrointestinal reactions and hematotoxicity, patients can tolerate. Conclusion Three-dimensional conformal radiotherapy synchronized weekly TP regimen chemotherapeutic treatment of advanced esophageal cancer in the short term efficacy and survival rate is good, although the adverse reactions increased but patients can tolerate.