后程加速超分割适形放疗联合卡培他滨治疗食管癌的疗效  

Efficacy of late accelerated hyperfractionated conformai radiotherapy combined with capecitabine for esophageal carcinoma

作　　者：盛巍[1] 冯鑫至 韩俊庆[1] 

机构地区：[1]山东大学附属省立医院肿瘤治疗中心,济南250021 [2]山东省医学影像研究所X线诊断室

出　　处：《中华肿瘤杂志》2011年第9期702-706,共5页Chinese Journal of Oncology

摘　　要：目的比较后程加速超分割适肜放疗联合卡培他滨与单纯后程加速超分割适形放疗及常规放疗治疗食管癌的疗效，探讨昔培他滨的放疗增敏作用。方法168例食管鳞癌患者随机分为3组，即常规放疗（CF）组（50例，2．0Gy／次，5次／周，总量60～66Gy）、后程加速超分割适形放疗（LCAF）组（55例，常规适形照射至40Gy后改为2次／d，1．3Gy／次，间隔6h，总量64—69Gy）和后程加速超分割适形放疗联合卡培他滨（LCAF＋C）组（63例，照射方法与LCAF组相同，放疗开始后口服卡培他滨至放疗结束），比较3组患者的近期疗效、生存率、放疗毒副反应和并发症等。结果CF组、LCAF组和LCAF＋C组患者的有效率分别为74．0％、85．5％和95．2％，差异有统计学意义（P=0．006）。CF组患者的1、3和5年局部控制率分别为64．0％、30．0％和24．0％，LCAF组患者的1、3和5年局部控制率分别为81．8％、65．5％和58．2％，LCAF＋C组患者的1、3和5年局部控制率分别为90．1％、77．8％和74．6％。CF组患者的1、3和5年生存率分别为58．0％、20．0％和8．0％，LCAF组患者的1、3和5年生存率分别为78．2％、36．4％和17．0％，LCAF＋C组患者的1、3和5年生存率分别为85．7％、55．6％和30．2％；LCAF组和LCAF＋C组患者的1、3和5年生存率均明显高于CF组（P值分别为0．024、0．001和0．007）。LCAF＋C组患者的5年局部控制率和5年生存率均明显高于LCAF组（P值分别为0．042和0．046）。LCAF＋C组和LCAF组急性放疗反应和并发症的发生率高于CF组，但放射性肺炎的发生率以及死于肿瘤未控或复发的比率低于CF组（均P〈0．05）。结论卡培他滨对食管癌放疗有增敏作用，它与后程加速超分割适形放疗结合能提高食管癌患者的局部控制率和生存率。Objective To evaluate the efficacy of late accelerated hyperfractionated conformal radiotherapy （LACF） combined with eapeeitabine on esophageal carcinoma. Methods One hundred and sixty eight patients of esophageal cancer were randomly divided into 3 groups, including the radiotherapy alone group （CF） which received conventional eonformal radiotherapy to a total of 60-66 Gy, LCAF group which received conventional fractionated conformal radiotherapy during the first two-thirds of the treatment to a dose about 40 Gy/20F/4W, then followed by late accelerated hyperfractionated conformal radiotherapy, twice daily radiotherapy at 1.3 Gy per fraction to a total dose about 64-69 Gy, and LCAF ＋ C group （late accelerated hyperfraetionated radiotherapy combined with capecitabine ）, in which patients were treated as the same as the LCAF group, except that they were treated with capecitabine （1.5 g po bid） from beginning of the radiotherapy to the end. Results The short-term results of the 3 groups were 74.0%, 85.5% and 95.2% , respectively（P = 0. 006）. The local control rates at 1, 3 and 5 years were 64.0%, 30.0%, 24.0% in the CF group, 81.8% , 65.5% , 58.2% in the LCAF group and 90.1% , 77.8% , 74.6% in the LCAF ＋ C group, respectively. The 1-, 3- and 5-year survival rates of the 3 groups were 58.0% , 20.0%, 8.0%;78.2%, 36.4%, 17.0% and 85.7%, 55.6%, 30.2%, respectively. The effect of LCAF ＋ C group was better than that of LCAF group and CF group. The incidence of acute tracheitis and acute esophagitis in the LCAF ＋ C group and LCAF group was higher than that in the CF group, but there was no stastistically significant difference between the 2 groups. There was no statistically significant difference in distant metastasis in the 3 groups. Conclusions Capecitabine, as an effective chemosensitizater combined with late accelerate hyperfractionated radiotherapy can improve the short-term results of treatment of esophageal cancer. The value of this combined treatment in distant metastasis reqires furth

关 键 词：食管肿瘤 放射治疗 卡培他滨 

分 类 号：R735.1[医药卫生—肿瘤]