三维适形放疗联合DF方案化疗治疗局部晚期食管癌临床观察

摘要

Objective:To evaluate the therapeutic effect,toxicity and survial rate of three dimensional-conformal radiotherapy(3D-CRT)combined with chemotherapy for locally advanced cancer of the esophagus. Methods:Total of 134 patients with locally advanced cancer of the esophagus were analysed retrospectively. All patients received 3D-CRT combined with chemotherapy DF(DDP and 5-FU),the total tumor does were 50-70Gy. 33 patients contin-ued chemotherapy with original scheme 1 course,36 patients continued chemotherapy with original scheme 2 courses, and 64 cases were without chemotherapy after radiation and chemotherapy. Results:The overall response( CR﹢PR) rate was 73. 9%. The one-year,two-year and there-year survival rates for all patients were 80. 5%,61. 5% and 47. 0%,respectively. After concurrent radiochemotherapy and chemotherapy 1 course,2 courses and without chemo-therapy,the median survival time was 41 months,62 months and 30 months(P=0. 493),respectively. The main ad-verse reactions were radioactive esophagitis,followed by hematotoxicity and gastrointestinal reactions,but they were tolerable. Conclusion:Synchronic radiochemotherapy could be given when patients lost operation chance,and had high score. Adverse reaction of patients can be tolerated. Chemotherapy 2 courses may have survival benefit after syn-chronic radiochemotherapy.%目的：探讨三维适形放疗联合同步化疗在局部晚期食管癌治疗中的近期有效率、毒副反应及生存率。方法：134例病人纳入本研究。采用三维适形放疗，常规分割，2.0Gy/次，1次/天，5天/周，放疗剂量50-70Gy。化疗为顺铂（DDP）75mg/m2第1天，静滴；氟尿嘧啶（5-FU）500mg/m2第1-4天，静滴，化疗在放疗第1、29天进行，共两个周期。33例放化疗结束后再原方案化疗1个疗程，36例放化疗结束后再原方案化疗2个疗程，64例放化疗结束后无化疗。结果：134例患者近期有效率为73.9％，1、2及3年的生存率分别为80.5％、61.5％和47.0％。同期放化疗后再化疗1、2个疗程及无化疗的中位生存时间分别为41、62和30个月（P＝0.493）。毒副反应主要是放射性食管炎，其次是血液毒性及胃肠道反应，患者均能耐受。结论：对失去了手术机会，评分较好的局部晚期食管癌患者，可考虑给予同期放化疗。毒副反应病人可以耐受。放疗后再化疗2个疗程可能对生存有获益。