三维适形放疗联合紫杉醇、奈达铂化疗治疗局部晚期食管癌的临床研究

摘要

Objective To evaluate the efficacy and toxicity of three- dimensional conformal radiotherapy combined with Paclitaxel plus Nedaplatin in the treatment of locally advanced esophageal carcinoma.Methods From June 2006 to February 2010,91 cases with StageⅡ andⅢ locally advanced esophageal carcinoma were randomized into the control group (Radiotherapy group) and the observe group (Concurrent chemoradiotherapy group). Two groups were treated by three-dimensional conformal radiotherapy. The control group was radiotherapy only with a total dose of 6000cGy to 7000cGy. The observe group was radiotherapy combined with 2 cycles chemotherapy with 135mg/m2 Paclitaxel on day 1 and 25mg/m2 Nedaplatin on days 1 to 3 every four weeks. 2 cycleschemotherapy was performed after radiotherapy.Results The overall response(CR + PR) rates of The observe group and the control group were 80.43% and 60% respectively(P<0.05). The 1, 2, 3 year local control rates of the observe group and the control group were 82.6%,56.5%,43.5% and 66.7%,40%,31.1%,respectively (P<0.05). The 1,2,3 year overall survival rate of the observe group and the control group were 78.3%,50%, 36.9% and 60%,33.3%,24.4%,respectively (P<0.05). The toxicity include gastrointestinal reaction, leukopenia and thrombocytopenia in the observe group were 58.7%、26.1% and 8.7% respectively comparing with 22.2%,4.4% and 2.2% respectively in the control group (P<0.05). However,there was no significant difference in radiation esophagitis between the two group.Conclusion The better short-term and long-term curative effect of locally advanced esophageal carcinoma could be achieved with concurrent chemoradiotherapy compared with radiotherapy alone. It is worthy for further research since most patients in observation group had high tolerance for the increasing toxicity.%探讨三维适形放疗联合紫杉醇、奈达铂化疗治疗局部晚期食管癌的疗效及不良反应。方法选取2006年6月～2010年2月高州市人民医院收治的临床分期Ⅱ～Ⅲ期局部晚期食管癌患者91例，随机分为2组，均采用三维适形放疗，处方剂量6000～7000 cGy。观察组在放疗期间联合化疗：紫杉醇135mg/m2，d1，奈达铂25mg/m2，d1～3，28d为1周期，化疗共4周期，与放疗同期2周期，放疗结束后2周期。结果观察组和对照组近期有效率（CR+PR）分别为80.43%和60%(P＜0.05)；观察组和对照组l、2、3年局控率分别为82.6%、56.5%、43.5%和66.7%、40%、31.1%，差异有统计学意义(P＜0.05)；1、2、3年生存率分别为78.3%、50%、36.9%和60%、33.3%、24.4%，差异有统计学意义(P＜0.05)；观察组的胃肠道反应、白细胞减少及血小板减少发生率分别为58.7%、26.1%和8.7%，高于对照组的22.2%、4.4%和2.2%，差异有统计学意义（P＜0.05）。2组放射性食管炎发生率无统计学意义。结论三维适形放疗联合紫杉醇、奈达铂化疗治疗局部晚期食管癌的近、远期疗效均优于单纯放疗，不良反应增加，但患者耐受性良好，值得进一步研究。