放疗联合顺铂、氟尿嘧啶方案同步治疗局部晚期食管癌的效果观察
Clinical effect of concurrent chemoradiotherapy of cisplatin and 5-fluorouracil on locally advanced esophageal carcinoma
-
摘要: 目的:探讨同步放化疗治疗局部晚期食管癌的疗效及不良反应。方法:根据入选标准随机将49例局部晚期食管癌患者分为单纯放疗组(单放组)24例和放疗+化疗组(放化组)25例。2组均采用60CO或6MV-X线放射治疗,食管癌原发灶剂量单放组为60~68 Gy,30~34分次,6.0~6.5周;放化组为54~60 Gy,27~30分次,5.5~6.0周,区域淋巴结剂量50~60Gy,25~30分次,5.0~6.0周。放化组从放疗第1天起给予氟尿嘧啶500 mg/m2静脉滴注5 d,顺铂20 mg/m2静脉滴注4 d。结果:放化组与单放组治疗有效率分别为92.00%和79.17%,差异无统计学意义(P;0.05)。放化组和单放组的1、2年生存率分别为68.00%、32.00%和58.33%、20.80%,差异均无统计学意义(P;0.05)。放化组和单放组的1、2年局控率分别为72.00%、36.00%和66.67%、25.00%,差异均无统计学意义(P;0.05)。放化组不良反应较单放组略有增加,但多数患者均能耐受。结论:放疗联合顺铂、氟尿嘧啶治疗局部晚期食管癌的近期疗效和局控率相对较好,有提高生存率可能,虽不良反应增加但多数患者可以耐受。Abstract: Objective:To evaluate the effectiveness and toxicity of concurrent chemoradiotherapy on locally advanced esophageal carcinoma. Methods:Forty-nine cases with locally advanced esophageal carcinoma were randomized into the first group(24 cases) treated only with radiotherapy and the second group(25 cases) treated with chemoradiotherapy combined cisplatin(20 mg/m2 day 1-4) and 5-fluorouracil(500 mg/m2 day 1-5).All cases were irradiated with60CO or 6MV-X ray.The radiation dose of the first group was 60-68 Gy in tumor for 30-34 times and sustained 6.0-6.5 weeks.The radiation dose of the second group was 54-60 Gy in tumor for 27-30 times and sustained 5.5-6.0 weeks,and 50-60 Gy,25-30 times and sustaining 5.0-6.0 weeks for regional lymph nodes.The second group were injected droply with 5-fluorouracil(500 mg/m2) for 5 days and cisplatin(20 mg/m2) for 4 days. Results:The effective rates of chemoradiotherapy group and radiotherapy group were 92.00% and 79.17%,respectively,the difference of the effective rates had no statistically significance(P0.05).The 1-year,2-year overall survival rate(OS) and locoregional progression-free survival(LPFS) of chemoradiotherapy group and radiotherapy group were 68.00%,32.00% and 58.33%,20.80%,and 72.00%,36.00% and 66.62%,25.00%,respectively.The LPFS and OS had no statistically significant difference between the two groups(P0.05).The toxicity of chemoradiotherapy group was heavier than the radiotherapy group,but the most patiens were tolerable. Conclusions:The chemoradiotherapy combined cisplatin and 5-fluorouracil can enhance the survival rate of patiens with locally advanced esophageal carcinoma and the adverse response is tolerable.
-
[1] Reed CE.Surgical management of esophageal carcinoma[J].Oncologist,1999,4(2):95-105. [2] 万均,肖爱幼,高淑珍,等.食管癌放疗后近期疗效评价标准--附1 000例分析[J].中国放射肿瘤学,1989,3(4):205-207. [3] 周际昌.抗肿瘤药的不良反应及处理 [M]//周际昌.实用肿瘤内科学.北京:人民卫生出版社,1998:205-297. [4] Cox JD,Stetz J,Pajak TF.Toxicity criteria of the Radiation Therapy Oncology Group(RTOG) and the European Organization for Research and Treatment of Cancer(EORTC)[J].Int J Radiat Oncol Biol Phys,1995,31(5):1341-1346. [5] Cooper JS,Guo MU,Herskovic A,et al.Chemoradiotherapy of locally advanced esophageal cancer:long-term follow-up of a prospective randomized trial(RTOG 85-01):Radiation Therapy Oncology Group[J].JAMA,1999,281(17):1623-1627. [6] Minsky BD,Pajak T,Ginsberg RJ,et al.INT 0123(RTOG 9405)phase Ⅲ trial of combined modality therapy for esophageal cancer:high dose(64.8 Gy)vs.standard dose(50.4 Gy)radiation therapy[J].Clin Oncol,2002,20(5):1167-1174. [7] 蔺强,高献书,乔学英,等.食管癌患者同期放化疗顺铂加氟尿嘧啶方案Ⅱ期临床试验[J].癌症,2008,27(10):1077-1081. [8] 王澜,韩春,李晓宁,等.中晚期食管癌三维适形放疗联合同期化疗的临床观察[J].中华肿瘤防治杂志,2010,17(24):2053-2056. [9] 刘俊,吕长兴,王家明.同步放化疗治疗不能手术的食管癌临床结果[J].中华放射肿瘤学杂志,2006,15(3):185-187. [10] 王新强,程秀祯,王世伟,等.放疗联合PF方案同期治疗中晚期食管癌[J].中华放射肿瘤学杂志,2005,14(3):215. [11] 李晓敏,王玉,戴建平,等.食管癌后程加速超分割放射治疗协同化疗的临床研究[J].中华放射肿瘤学杂志,2003,12(1):1-3. [12] 张好,俞明根,钱荣誉,等.食管癌后程加速超分割放疗协同化疗的疗效评价[J].中华放射肿瘤学杂志,2006,15(2):89-92. [13] 王澜,王军,韩春,等.食管癌同期放化疗的价值研究[J].中华放射肿瘤学杂志,2011,20(4):291-295. [14] 陈尔成,刘孟忠,胡永红,等.不能手术切除行同期放化疗的食管癌患者预后的多因素分析[J].癌症,2005,24(6):731-734. [15] 中国非手术治疗食管癌临床分期专家小组.非手术治疗食管癌临床分期标准[J].中华放射肿瘤学杂志,2010,19(3):179-180. [16] 王玉祥,祝淑钗,邱嵘,等.三维适形放疗治疗T4期食管癌预后分析[J].肿瘤防治研究,2011,38(6):690-694. [17] Shimada H,Shiratori T,Takeda A,et al.Perioperative changes of serum p53 antibody titer is a predictor for survival in patients with esophageal squamous cell carcinoma[J].World J Surg,2009,33(2):272-277. -

计量
- 文章访问数: 2978
- HTML全文浏览量: 391
- PDF下载量: 226
- 被引次数: 0