三维适形放射治疗配合同期化疗治疗食管癌术后局部复发的临床研究

摘要

Objecthe:To study the effect of concurrent chemoradiotherapy with PF regiment vs radiotherapy alone for regional recurmce m esophageal carcinoma after radical surgery and its prognostics factor.Methods : From January 2003 to September 2005 ,90 eligible patients with postoperative squamous cell carcinoma of esophagus were randomized into the study.Forty - five patients were given three dimensional conformal radiotherapy alone( CF group) , who received conventional fractionation dunng radiotherapy course.The dose was 50Gy/25d for PTV, boost for GTV to a total dose of 64 Gy/46d.Forty - five patients enrolled to the concurrent chemoradiotherapy group( CMF group) . who received two cycles of chemotherapy during radiotherapy followed by additional two cycles chemotherapy.The regimen of chemotherapy consisted of cisplantin 20mg/m2/d and fluorouracil (5 - FU) 500mg/m2/d from day 1 to day 4 .Ihe interval between each cycle was 4 weeks.Results: The median survival was 24.O months in CMF group, 17.5montha in CF.In CF group , the survival rates at 1,2,3 years were 66.7％ ,31.1％ and 15.6％ , respectively ,whereas they were 68.9％ ,49.9％ and 35.6％ in CMF group( P = 0.03) .The complete reaponse rates were 53.3％in CMF group, and 20 in CF group(P =0.001) , respectively.Three - year distant metastasis rates were 26.7％ in CMF group, and 40％ in CF group(P = 0.18) .Metastatic number, whether or not chemotherapy and tumor size were independent prognostic factors.The acute toxicities were higher in CMF group than CF group.Conclusion : Concurrent chemoradiotherapy may decrease distant metastasis rate and increase complete response rate and overall survival compared with CF alone , but acute toxicities were high.%目的:研究同期放化疗和单纯放疗治疗食管癌术后局部复发的疗效、毒性反应和预后因数.方法:自2003年1月至2005年9月共90例食管癌术后局部复发的患者随机分为放疗组和放化组各45例.放疗组给予PTV(plan target volume)50Gy/25次,对GTV(gross target volume)推量至64Gy;同期放化疗组放疗方案同上,化疗从放射治疗的第1天开始,DDP 20mg/m2/d, 5-FU 500mg/m2/d,静脉注射, 连用4天.放疗期间用2周期,放疗结束后再用2周期,每4周1个周期.结果:放疗组和放化组的中位生存期分别为16.4和23.5月,1、2、3年生存率分别为66.7%、31.1%、 15.6%和 68.9%、48.9% 、 35.6%(P＝0.03);完全缓解率放疗组和放化组分别为20%和53.3%(P=0.001);远处转移率(包括远处脏器和区域外淋巴结转移)分别为 40%例和26.7%,放化组略减少了远处转移,但无显著性差异(P=0.18).多因数分析显示多发转移、没有化疗、病灶大于4cm生存率较差;急性毒性反应放化组高于放疗组(P＜0.05).结论:食管癌术后区域性复发同期放化疗,能明显提高局部病灶的完全缓解率,略减少了远处转移,提高了总生存率,但毒性反应增加.