老年食管癌患者化疗联合后程加速超分割放疗的疗效分析  

Late course accelerated hyperfractionation radiotherapy combined with chemotherapy for elderly patients with esophageal carcinoma

作　　者：鲁广[1] 何美文[1] 张永伟[1] 

机构地区：[1]浙江萧山医院放疗科,浙江萧山300201

出　　处：《中国癌症杂志》2010年第4期285-289,共5页China Oncology

摘　　要：背景与目的:后程加速超分割放射治疗(late course accelerated hyperfractionation radiotherapy,LCAF)以及联合化疗的加入可提高食管癌治疗疗效,但出于对并发症及治疗不良反应的担忧,老年食管癌患者多趋向于接受相对保守的治疗方案。本研究旨在探讨化疗联合LCAF用于老年食管癌患者的安全性及有效性。方法:回顾性分析2005年1月—2007年12月期间在本院接受放化综合治疗非转移老年食管鳞癌患者的临床资料,共37例(其中男性21例,女性16例),中位年龄70岁(65～78岁)。并发症评分Charlson指数中位值为2,其中15例(40.5%)Charlson指数>2。患者在接受2个周期的PF方案诱导化疗后行放疗,采用LCAT方案(53.4～68.4Gy,31～41分次,37～51d)。全组中位化疗周期数为4次(2～6个周期)。结果:35例(95%)患者完成了预定的放射治疗,13例(35.1%)出现了Ⅲ级及以上的不良反应,无治疗相关死亡病例,而Charlson>2者发生Ⅲ或Ⅳ级不良反应的比例更高(P=0.003)。全组病例随访至2009年6月,失访1例,存活15例(40.5%),其中13例(35.1%)无瘤生存。全组中位生存时间为34.4个月(95%CI:33.0～35.8个月),1、2和3年生存率为75.7%、63.5%和37.9%,1、2和3年局控率为84.0%、72.9%和56.7%。Charlson≤2者中位生存期要优于Charlson>2者,但差异并无统计学意义(38.2个月∶34.4个月,P=0.214)。结论:对经选择的老年食管癌患者给予积极的放化综合治疗,耐受性及治疗疗效并不明显弱于年轻患者,值得进一步研究。Background and purpose：Late course accelerated hyperfractionation radiotherapy combined with chemotherapy can effectively improved the treatment outcome for patients with esophageal carcinoma.Elderly patients with cancer tend to receive more conservative treatments in terms of treatment toxicity and comorbidity.The aim of this study was to investigate the toxicity and effects of late course accelerated hyperfractionation radiotherapy combined with chemotherapy in elderly patients with esophageal carcinoma.Methods：A total of 37 elderly patients with non-metastatic esophageal carcinoma who were given combined chemoradiotherapy were analyzed retrospectively.There were 21 male and 16 female the median age was 70 years old（range：65 to 78 years old）.The median Charlson score, which was used for the analysis of patient＇s comorbidities was 2.Fifteen patients（40.5%） had a Charlson score 2.Each patient received 2 cycles of induction chemotherapy with 5-FU/cisplatin, followed by late course accelerated hyperfractionation radiotherapy（53.4-68.4 Gy in 31-41 fraction in 37-51 days）.The median cycle of chemotherapy was 4（range：2 to 6）.Results：Thirty-f ive patients（95%） completed the planned radiotherapy.Thirty patients（35.1%） experienced grade Ⅲ-Ⅳ toxicity.No treatment-related death occurred.There was a correlation between the Charlson scores and the grade 3 or 4 toxicity（P=0.003）.Follow up was conducted with all patients until June of 2009（with one patient censored）, fifteen patients（40.5%） are alive and 13（35.1%） remain alive without evidence of recurrence or progressiveness.The median overall survival length was 34.4 months.1, 2 and 3-year survival rates were 75.7%, 63.5% and 37.9%, respectively.There was no significant difference in overall survival rates between those with a Charlson score ≤ 2 and 2（38.2 vs 34.4 months, P=0.214）.The 1, 2 and 3-year local control rates were 84.0%, 72.9% and 56.7%, respectively.Conclusion：When given a sufficient combination of m

关 键 词：食管肿瘤/放射疗法 剂量分割分次 食管肿瘤/化学治疗 治疗疗效 

分 类 号：R735.1[医药卫生—肿瘤]