去氧氟尿苷联合后程加速超分割放射治疗食管癌临床观察  

Clinical effective analysis of doxifluridine combined with late course accelerated hyperfractionated radiotherapy for esophageal carcinoma

作　　者：朱川[1] 李刚[1] 刘必宽[1] 任必勇[1] 邓超[1] 张军[1] 张力[1] 刘学芬[1] 熊德明[1] 

机构地区：[1]重庆三峡中心医院肿瘤防治研究所,重庆404000

出　　处：《中国癌症杂志》2008年第10期770-774,共5页China Oncology

基　　金：重庆市医学重点研究室建设项目资助(No.2007-14)。

摘　　要：背景与目的:同步放化疗是食管癌非手术治疗的一种新综合治疗模式,较单独放疗可以改善预后;采用单药去氧氟尿苷联合后程加速超分割同步放化疗(late course accelerated hyperfrationated radiotherapy,LCAFR)方法治疗食管癌国内报道较少,本研究旨在评价单药去氧氟尿苷联合LCAFR治疗食管癌的临床疗效和毒副反应。方法:114例食管癌患者分为两组,联合组57例予以单药去氧氟尿苷联合LCAFR协同治疗,观察疗效和毒副反应发生情况。LCAFR前1/2疗程常规分割放疗至30～36Gy(1.8～2.0Gy/次,1次/d,5d/周),后1/2疗程缩野后改用后程加速超分割(1.5Gy/次,2次/d,5d/周),全程总剂量60～70Gy,35～42分次,37～42d完成。在上述放疗的同时进行化疗,从放疗第1天给予去氧氟尿苷0.2g口服,每天4次,连用14d,28d为1个周期,共2～3个周期。对照组57例仅采用单独放射治疗,放疗方法同治疗组。结果:两组近期总有效率分别为联合组91.2%(52/57),对照组73.7%(42/57),差异有显著性(P<0.05)。食管局部病灶1年控制率联合组为84.2%(48/57),对照组为71.9%(41/57),差异有显著性(P<0.05)。1年生存率联合组为70.2%,对照组为68.4%,差异无显著性(P>0.05)。联合组主要毒副反应为放射性食管炎和骨髓抑制,其中Ⅲ度以上发生率分别为19.3%(11/57)和12.3%(7/57);对照组主要毒副反应与联合组相似,其中Ⅲ度以上相关反应发生率分别为15.8%(9/57)和5.3%(3/57)。结论:单药去氧氟尿苷联合LCAFR可作为提高食管癌近期疗效的一种重要手段,毒副反应易于耐受,对食管癌患者远期生存受益尚需进一步研究。Background and purpose：Concurrent chemoradiotherapy is a new non-surgical modality which could improve prognosis for esophageal carcinoma as compared with radiotherapy alone. Treatment for esophageal carcinoma with doxifluridine combined with late course accelerated hyperfraction radiotherapy（LCAHR） has rarely been reported. The clinical efficacy and side effects after treatment on esophageal carcinoma with doxifluridine combined with LCAHR were evaluated in this study. Methods：A total of 114 patients with esophageal carcinoma were randomized to receive either chemoradiotherapy or radiotherapy alone. 57 patients received late course accelerated hyperfractionated radiotherapy combined with doxifluridine as compared with radiotherapy alone for 57 patients.All patients received conventional radiotherapy 30-36 Gy in 15-18 fractions,then followed by LCAHR with 30-34 Gy in 10-12 fractions,（1.5 Gy per fraction, twice per day） to a total dose of 60-70 Gy in 34-42 fractions over 37-42 days. In concurrent chemoradiotherapy group, patients also received doxifluridine as a single drug oral chemotherapy regimen, 200mg/ qid,p.o., for 14 consecutive days, every 28 days as one cycle for total 2-3 cycles. Results：The total effective rate was 91.2% （52/57） in concurrent group, and 73.7%（42/57） in radiation group （P〈0.05）, respectively. The 1-year local control rate was 84.2%（48/57） and 71.9%（41/57）, respectively. The 1-year survival rate was 70.2% in concurrent group, and 68.4% in radiation alone group （P〉0.05）. The most common grade 3 or 4 side effect was radiotherapy related esophagitis 19.3%（11/57） and bone marrow suppression 12.3%（7/57） in concurrent group. Conclusions：It is possible that doxifluridine as concurrent oral chemotherapy regimen combined with LCAHR can be selected as an effective treatment for esophageal carcinoma. No serious side effects were observed. Further study of long term survival benefi t for esophageal carcinoma patients is awaited.

关 键 词：食管癌 放射疗法 化学疗法 超分割放射治疗 去氧氟尿苷 

分 类 号：R735.1[医药卫生—肿瘤] R730.53[医药卫生—临床医学]