同步放化疗与单纯放疗用于不能手术食管癌的比较分析  

A Study on Unresectable Esophageal Carcinoma Patients with Radiochemotherapy or Radiotherapy

作　　者：谢志原[1] 陈辉林[1] 王永川[1] 陈素真[1] 林育毅[2] 刘庆丰[1] 

机构地区：[1]福建省安溪县医院放疗科,福建安溪362400 [2]厦门市第二医院,福建厦门361021

出　　处：《黑龙江医学》2011年第10期733-736,共4页Heilongjiang Medical Journal

摘　　要：目的对不能手术的食管癌患者,进行同期放化疗、单纯放疗不同亚组生存分析,明确同步放化疗的临床应用阶值。方法回顾性分析140例不能手术的食管鳞癌患者,同步化放疗组70例,单纯放疗组70例,比较两组疗效、总生存率、毒副反应、失败原因。放疗采用常规分割方式,总剂量60～66Gy;化疗采用替加氟+卡铂方案。结果同步放化疗组的1、2、3年生存率为70.0%(49/70)、54.3%(38/70)、35.7%(25/70);单纯放疗组的1、2、3年生存率分别为51.4%(36/70)、37.1%(26/70)、20.0%(14/70)。同期放化疗可显著提高T3、N1、M0期亚组的1年生存率(χ2=4.480、4.837、4.406,P=0.034、0.028、0.036),同步化疗组和单纯放疗组的恶心、呕吐、Ⅲ～Ⅳ级食管炎、Ⅲ～Ⅳ级骨髓抑制发生率分别为77.1%、34.3%、21.4%和57.1%、11.4%、8.6%(χ2=6.346、10.370、4.538,P=0.012、0.001、0.033),其它急性毒性反应、晚期副反应相似(P值均>0.05)。同步放化疗组、单纯放疗组的局部复发率分别42.9%和60.0%(χ2=4.118,P=0.042),远处转移率分别为12.9%和18.6%(χ2=0.863,P=0.253)。结论同步放化综合治疗不能手术食管癌患者,可提高其总生存率和T3、N1、M0亚组生存率,降低局部复发率,但未能降低远处转移率,且恶心呕吐、Ⅲ～Ⅳ食管炎、Ⅲ～Ⅳ级骨髓抑制发生率显著增加。Objective To observe the clinical value of tegafur combined with carboplatin concurrent chemoradiation for the patients with unresectable esophagus carcinoma.Methods 140 patients with unresectable esophageal carcinoma were adopted in this study.Half patients were given concurrent radiochemotherapy（RCT） and the others were given radiotherapy alone（RT）.The overall survival rates,side effects and causes of failure between the two groups were compared.The chemotherapy using tegafur combined with carboplatin.Total dose of irradiation ranged from 60-66Gy.Results The 1-year,2-year,3-year survival rates in the RCT group were 70.0%（49/70）,54.3%（38/70）,35.7%（25/70） respectively.The 1-year,2-year,3-year survival rates in the RT group were 51.4%（36/70）,37.1%（26/70）,20.0%（14/70）respectively.The overall survival rate of patients with T3,N1,and M0 were significantly higher in the CRT group than in the RT group（χ2=4.480,4.837,4.406,P=0.034,0.028,0.036）.Nausea,vomiting,Grade 3-4 toxicites of hematopoietic suppression and esophagit were 77.1%、34.3%、21.4% in the RCT group;and 57.1%、11.4%、8.6% in the RT group,respectively（χ2=6.346,10.370,4.538,P=0.012,0.001,0.033）.The other acute toxicities and late side effects have no significant difference between the two groups（P0.05）.The local fail was significant difference between the two group（42.9%： 60.0%,χ2=4.118,P=0.042）,but no significant difference was found in the distant metastases（12.9%： 18.6%,χ2=0.863,P=0.253）.Conclusion Compared with radiotherapy alone,concurrent radiochemotherapy could significantly improve the overall survival and local control of patients with unresectable esophageal carcinoma,but it is failed to reduce the distant metastasis.Patients treated with Radiochemotherapy are developed nausea and vomitting,grade 3-4 toxicity marrow suppression and esophagitis.Radiochemotherapy is also benefitial to the group of patients with T3,N1,and M1.

关 键 词：食管肿瘤/放射疗法 食管肿瘤/化学疗法 同步 

分 类 号：R735.1[医药卫生—肿瘤]