内外照射加卡铂化疗治疗食管癌的前瞻性随机分组研究  

Combination of External Beam and Intracavitary Radiation and Carboplatin Chemotherapy in the Treatment of Esophageal Carcinoma

作　　者：祝淑钗[1] 万钧[1] 周道安[1] 杨天恩[2] 

机构地区：[1]河北医科大学第四医院放疗科,石家庄市050011 [2]天津医科大学总医院放疗科

出　　处：《中国肿瘤临床》2000年第1期5-8,共4页Chinese Journal of Clinical Oncology

基　　金：河北省科委科研基金

摘　　要：目的 :评价内外照射结合加卡铂化疗综合治疗中晚期食管癌的远期疗效和并发症。方法 :1993年8月至1994年5月 ,对129例中晚期食管癌行前瞻性随机分组研究。全部病例经病理证实。随访均满4年 ,随访率98.5 %。A组33例单纯常规外照射肿瘤总量60Gy/30次/6周。B组32例先常规外照射肿瘤量达38Gy/19次时 ,开始腔内照射 ,结束时外照总量50Gy/5.5周 ,腔内总量15～16Gy/3次/3周。C组31例放疗同B组 ,仅在第1周和第6周静点卡铂100mg/次/日 ,连续5天为一疗程 ,前后2个疗程。D组33例放疗同A组 ,化疗同C组。结果 :3年生存率D组39.4 %与A组15.2 %比较有统计学差异P=0.027 ,4年生存率 ,D组为30.3 %(10/33)亦明显高于A组12.1 %(4/33) ,P=0.071 ;并发现3年无病生存率 ,D组为36.4 %(12/33)明显高于A组15.2 %(5/33) ,P=0.048 ;A、B、C、D四组的中位生存期分别为12个月、18个月、13个月、16个月。放疗后并发症包括良性食管狭窄、溃疡和瘘 ,溃疡和瘘的发生率在四组间无差别 ;A、B、C、D四组良性狭窄发生率分别为9.1 %(3/33)、43.8 %(14/32)、38.7 %(12/31)、12.1 %(4/33) ,A、D组与B、C组比较均有统计学差别 ,P<0.05。全组已死亡108例 ,局部失败致死63例 ,占58.3 % ,死于局部复发者 ,A组为55.2 %(16/29) ,明显高于B组22.2 %(6/27)Purpose: To study the effect and complications of external beam and intracavitary radiation with carboplatin chemotherapy for esophageal carcinoma. Methode: From August 1993 to May 1994, 129 mid-term and advanced esophageal carcinoma patients were treated by combined radiotherapy and chemotherapy with prospective randomized study. All of this series were squamous cell carcinoma. The follow-up rate was 98.5%. Group A: 33 patients received conventional radiotherapy to a dose of 60Gy/30F/6W. Group B: 32 patients were given external and intracavitary irradiation to a dose of 50Gy/25F/5.5W and 15～16Gy/3F/3W respectively. Group C: 31 patients received radiotherapy as same as B group, and carboplatin 100mg/day for 5 days as a course and two courses were given. Group D:33 patients were given radiotherapy as same as A group and the chemotherapy regimen identified to C group. Results: The 3-, 4-year survival rates existed significant difference between A and D groups P=0.027 and P=0.071 respectively. The 3-year disease-free survival rate of D group 36.9%(12/33) was higher than that of A group 15.2%(5/33) P=0.048. The A, B, C and D groups median survival times were 12, 18,13 and 16 months respectively. There was no significant difference in any group about the non-carcinomatous ulcer and fistula mortality, but the stenosis in B, C groups were 43.8% (14/32) and 38.5% (12/31) respectively which were higher than those of A, D groups 9.1%(3/33) and 12.1%(4/33), P< 0.05. One hundred and eight patients had died. The local failure resulted in dead 63 cases (58.3%). In group A, death from local relapse was 55.2% (16/29) much higher than those in B group 22.2% (6/27) P=0.012 and C group 21.4% (6/28) P=0.009. Conclusion: The combined external and intracavitary radiation shows that local relapse lowered, but could not improve the long-term survival, and that the severe complications markedly influenced the quality of life and the long-term survival. Combined radiation plus carboplatin chemotherapy seems to improve

关 键 词：食管肿瘤 卡铂 放射疗法 药物疗法 

分 类 号：R735.1[医药卫生—肿瘤]