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
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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.
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