卡培他滨节拍化疗联合SIB－IMRT治疗高龄食管癌疗效及安全性分析

摘要

目的:观察卡培他滨节拍化疗联合同期加量三维调强放射治疗(SIB－IMRT)方案治疗高龄食管癌 患者的疗效及安全性.方法:收集52例年龄≥70岁的Ⅰ－Ⅲ期食管癌未手术患者,化疗方案选择低剂量单药卡培他滨节拍化疗,600 mg/m2,bid,28 d为1个周期,共4个周期,放疗方案选择SIB－IMRT,PGTV 60.2 Gy/28 f,PTV 50.4 Gy/28 f.观察并记录疗效及放化疗不良反应,评价该方案的治疗效果与安全性.结果:全组患者中50例完成治疗,2例因心脏疾病加重而终止放化疗.客观缓解率(ORR)为80.77％,疾病控制率(DCR)为86.54％;患者1、2、3年的生存率分别为78.85％、61.54％、40.38％;放化疗前后KPS评分均值分别为69.62分和84.23分(P＜0.05);放化疗前后QLQ－OES24评分分别为(63.56 ± 7.21)和(80.16 ± 6.51)(P＜0.05).不良反应,全组患者发生≥Ⅱ级放射性食管炎7例、≥Ⅱ级放射性气管炎6例、≥Ⅱ级胃肠道反应10例、≥Ⅱ级骨髓抑制19例、≥Ⅱ级手足综合征4例、≥Ⅱ级放射性肺炎3例、肝功能损害3例、食管狭窄2例、食管穿孔0例.结论:卡培他滨节拍化疗联合SIB－IMRT治疗高龄食管癌患者的疗效可靠,不良反应可耐受,安全性高,适合于高龄食管癌患者临床应用.%Objective:To observe the efficacy and safety of capecitabine metronomic chemotherapy with SIB－IM-RT regimen in the treatment of elderly patients with esophageal cancer.Methods:Fifty－two patients aged more than 70 years with Ⅰ－Ⅲ esophageal cancer patient were involved in this program.Low－dose of capecitabine(600 mg/m2,bid)was administrated in the four metronomic chemotherapy periods(28 d per period),combing treatment with SIB－IMRT at the doses of PGTV 60.2 Gy/28 f and PTV 50.4 Gy/28 f.The efficacy and the adverse reaction were investigated and it safety was evaluated.Results:Of all the patients,50 finished the treatment scheme,and 2 cases were stopped because of the aggravation of heart disease.The total efficacy was evaluated as 80.77％(ORR)and 86.54％(DCR),respectively.The survival rates in 1,2,3 years were 78.85％,61.54％and 40.38％,respectively.The KPS scores before and after treatment were 69.62 and 84.23,respectively(P＜0.05).The QLQ－OES24 scores before and after treated were(63.56 ± 7.21)and(80.16 ± 6.51),respectively(P＜0.05).Different adverse reac-tions were recorded in this program,and 7 cases with≥Ⅱ grade esophagitis,6 with≥Ⅱ grade radioactive bronchitis,10 with ≥Ⅱ grade gastrointestinal reactions,19 with≥Ⅱ grade myelosuppression,4 with≥Ⅱ grade grade hand－foot syndrome,3 with ≥Ⅱ grade radiation pneumonia,3 with liver damage,2 with esophageal stricture,respectively,and no case of esophageal perforation was found.Conclusion:The results of this investigation showed that the metronomic chemotherapy of capecitabine combining with SIB－IMRT is effective and safe with tolerable adverse reactions,infer-ring the scheme is applicable in treatment on elderly esophageal cancer.