目的 探讨调强适形放疗与联合放化疗两种治疗方案应用于食管癌患者的临床疗效及安全性.方法 回顾性分析2011年2月~2013年12月收治的186例食管癌患者的临床资料,根据治疗方案的不同分为调强适形放疗组(80例)与联合放化疗组(106例),比较两组患者的生存情况及毒性反应.结果 截至2015年5月12日,随访率为97.8%,1年、2年、3年生存率分别为60.1%、36.3%、31.5%,中位生存时间为16个月(95% CI:12.9~19.1);联合放化疗组1年、2年、3年生存率分别为68.2%、44.5%、37.3%,中位生存时间21个月;单纯放疗组1年、2年、3年生存率分别为49.3%、26.1%、24.1%,中位生存时间12个月;两组比较,差异有统计学意义(P=0.013).两组TNM分期亚组中N1患者总生存率及无进展生存率比较,差异有统计学意义(x2=6.164/6.869, P=0.013/0.009),M1a患者总生存率比较差异有统计学意义 (x2=5.635, P=0.018).联合放化疗组毒性反应发生率显著高于调强适形放疗组,主要表现为血小板、白细胞及血红蛋白下降(P=0.030,0.036,0.095).结论 调强放疗同步放化疗治疗食管癌的疗效优于单纯放疗,特别是N1 和M1a期患者;不良反应发生率高于单纯放疗组,但均可耐受.%Objective Retrospective analysis of intensity modulated radiation therapy (IMRT) and combined radio-chemotherapy for treat-ment of esophageal cancer patients. Methods Retrospective analysis of 186 esophageal cancer patients' clinical data that accepted IMRT in our department from February 2011 to December 2013.106 esophageal cancer patients were treated with combined radio-chemotherapy and 80 esophageal cancer patients were treated with intensity modulated radiation therapy. Compare the survival situation and toxic reaction between the two groups. Results Until May 12, 2015, all patients' follow-up rate was 97.8%. Total survival rates of 1-, 2-, 3-year in two groups were 60.1%, 36.3%, 31.5% respectively, the median survival time was 16 months (95% CI: 12.9~19.1). Total survival rates of 1, 2, 3-year in com-bined radio-chemotherapy group were 68.2%, 44.5% and 37.3% respectively, the median survival time was 21 months. Total survival rates of 1-, 2-, 3-year in radiation therapy alone group were 49.3%、26.1%、24.1% respectively, the median survival time was 12 months, the difference was significant (x2=6.151, P=0.013). There were significant differences in the total survival and progression-free survival rate of N1 stage between the two groups (x2=6.164/6.869, P=0.013/0.009). There were also significant difference in total survival rate of M1a stage between the two groups (x2=5.635, P=0.018). The toxic reaction incidence of combined radio-chemotherapy group was higher than radiation therapy alone, mainly including decrease of platelets, white blood cells and hemoglobin (P=0.030/0.036/0.095). Conclusion Compared with radiation therapy alone, combined radiation and chemotherapy can improve the survival rate of esophageal cancer patients, especially for patients of N1 and M1a stage. The toxic reaction incidence of combined radiochemotherapy group was higher, but all were tolerated.
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