食管癌术前同步多西他赛联合顺铂化放疗的临床观察  

Cinical study of docetaxol combined with cisplatin in neo-adjuvant chemo-radiotherapy for esophageal carcinoma

作　　者：丁颖[1] 苏琼菲[1] 杨帆[1] 刘晓清[1] 彭苗[1] 莫凯岚[1] 王希成[1] 

机构地区：[1]广东药学院附属第一医院肿瘤科,广东广州510080

出　　处：《中华肿瘤防治杂志》2012年第9期679-682,共4页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的:探讨多西他赛联合顺铂术前同步放化疗治疗食管癌的疗效。方法:对22例食管癌初治患者采用术前同步放化疗。放疗采用三维适形放疗技术(3DCRT),处方剂量46Gy/23次,在放疗的第1和4周均给予多西他赛和顺铂化疗2个周期。放化疗结束后休息4～6周,行食管癌根治术。结果:22例患者完成术前放化疗,术前放化疗的临床有效率为81.8%(18/22)。21例患者进一步接受手术,根治性切除率为95.2%,病理完全缓解率为38.1%(8/21)。与治疗前分期比较,T与N分期均明显提前,P值均<0.05。放化疗导致的Ⅲ级以上不良反应主要为白细胞下降、呕吐及放射性食管炎。肺部感染、吻合口瘘、伤口延迟愈合及乳糜胸均为4.8%(1/21)。中位随访时间45个月,3和5年生存率分别为61.9%和47.6%,中位生存时间49个月。3和5年无病生存率分别为50.2%和40.5%,中位无病生存时间为35个月。结论:多西他赛联合顺铂术前同步放化疗并手术治疗食管癌可取得较高的临床有效率和完全病理缓解率,明显降低食管癌的分期,有望提高局部中晚期食管癌的生存率。本治疗方案,患者耐受性良好,无治疗相关性的死亡。OBJECTIVE：To investigate the prognosis of esophageal carcinoma receiving docetaxol combined with cisplatin in neo-adjuvant chemo-radiotherapy followed by surgery. METHODS： Twenty-two patients with primary diagnosis of esophageal carcinoma were into this study. The radiotherapy used three dimensional conformal radiotherapy and the prescribed dose was 46 Gy/23 F. The chemotherapy consisted of docetaxol and cisplatin. The chemotherapy was administered in continuous infusion for the first week and the fourth week. After completion of chemo-radiotherapy, clinical restaging was performed. Esophageetomy and lymphadenectomies were performed 4--6 weeks after chemo-radiotherapy. RESULTS： Twenty-two patients finished the preoperative ehemo-radiotherapy. The clinical response rate of chemo-radio- therapy was 81.8% （18/22）. Twenty-one cases continued to received esophagectomy, the rate of radical resection was 95.2% and the pathological complete response rate was 38.1% （8/21）. The T and N were downstaged compared to the pre-treatment,. Toxicity grade 3--4 included leucopenia,vomiting and radiation esophagitis. Surgery-related complica- tions included pulmonary infection （ 4. 8 %, 1/21 ） , anastomotic leakage （4. 8 %, 1/21 ）, wound delay healing （4. 8 %, 1 /21 ）, and chylothorax （ 4.8 %, 1/21 ）. Overall survival at 3,5 years were 61.9 %, 47.6 %, respectively and the median survival was 49 months. Disease-free survival at 3,5 years were 50.2 %, 40.5 %, respectively and the median disease-free sur- vival was 35 months. CONCLUSIONS： This neoadjuvant chemo-radiation（docetaxol combined cisplatin with radiotherapy） followed by surgery can achieve a high clinical response rate and pathologic complete tumor remission rate and significantly downstage the esophageal cancer. This multidiscipline therapy may hopefully improve the survival. In this treatment no death occured during chemo-radiotherapy.

关 键 词：食管肿瘤 放射疗法 药物疗法 外科手术 

分 类 号：R735.1[医药卫生—肿瘤]