TP诱导联合DDP同期放化疗治疗局部晚期食管癌临床研究  

The clinical trial of induction chemotherapy with cisplatin and docetaxel followed by radiation concurrent with weekly cisplatin for locally advanced esophageal cancer

作　　者：郑明章[1] 黄利生[1] 林柏翰[1] 伍方财[1] 陈创珍[1] 庄婷婷[1] 陈志坚[1] 

机构地区：[1]汕头大学医学院附属肿瘤医院,广东省汕头市515031

出　　处：《中国肿瘤临床》2013年第18期1119-1122,共4页Chinese Journal of Clinical Oncology

摘　　要：目的:研究不适手术的局部晚期食管癌患者行TP方案诱导化疗联合DDP同期放化疗的毒性及疗效。方法:33例胸段食管鳞癌T3N0MO^T4N2M0期患者(不包括腹腔淋巴结转移),第1天和第22天行TP方案诱导化疗,多西他赛(艾素)75 mg/m2,DDP 75 mg/m2。第43天开始放疗,采用三维适形放疗,总剂量60 Gy,2 Gy/次,5次/周。同期化疗:DDP 30 mg/m2,1次/周,放疗开始的第1、8、15、22、29、36天给药。结果:诱导化疗Ⅳ级骨髓毒性为12.12%(4/33),无Ⅲ级或以上的肝、肾毒性。同期放化疗骨髓毒性最高为Ⅲ级,红细胞、粒细胞、血小板Ⅲ级毒性分别为21.21%(7/33)、15.15%(5/33)、3.03%(1/33),无Ⅱ级以上的肝肾毒性。Ⅲ级放射性食管炎为9.10%(3/33),未发现Ⅲ级以上的放射性食管炎及Ⅰ级以上的急性放射性肺炎。治疗结束评价显效(CR+PR)84.85%(28/33),稳定(SD)12.12%(4/33),进展(PD)3.03%(1/33);治疗后2个月评价显效(CR+PR)75.76%(25/33),稳定(SD)9.10%(3/33),进展(PD)15.15%(5/33)。全组死亡病例15例。1年生存率66.4%,最主要失败模式是局部失败46.67%(7/15),局部+远处失败26.67%(4/15)。结论:局部晚期食管癌患者行TP方案诱导化疗+DDP同期放化疗的毒性可以耐受,局部失败仍然是主要的失败模式。Objective： To assess the safety and efficacy of induction chemotherapy with cisplatin and docetaxel followed by radiation concurrent with weekly cisplatin for unresectable, locally advanced esophageal cancer. Methods： Thirty-three patients with T3NOM0 to T4N2M0 thoracic esophageal squamous cell carcinoma without celiac lymph node metastasis were included in the study. They were treated with cisplatin （75 mg/m2 dl, d22） and docetaxel （75 rag/m2 dl, d22） neoadjuvant chemotherapy followed by three-dimensional conformal radiotherapy （60Gy/30F/6w） concurrent with cisplatin （30 mg/m2 dl, 8, 15, 22, 29, 36 from the beginning of radiation）. Results： Grade 4 hematological toxicities were observed in 13.33% （4/33） of the patients after the neoadjuvant chemother apy. No grade 3 or above hepatic or renal toxicities were found. During concurrent chemoradiation, the highest grade 3 hematological toxicities were observed in the erythrocyte, granulocyte, and macrophage at 21.21% （7/33）, 15.15% （5/33）, and 3.01% （1/33）, respectively. No grade 2 or above hepatic or renal toxicities were observed. Grade 3 radiation esophagitis was observed in 9.1% （3/33） of the patients, whereas grade 3 and above radiation esophagitis or grade 1 and above acute radiation pneumonitis did not occur. The evaluation results after treatment completion were 84.85% （28/33）, 12.12% （4/33）, and 3.03% （1/33） for CR＋PR, SD, and PD, respectively. Two months after treatment completion, the results changed to 75.76% （25/33）, 9.10% （3/33）, and 15.15% （5/33）, respectively. Overall, 15 patients died. The one-year survival rate was 66.4%. Local failure was approximately 46.67% （7/15）, whereas the local＋distant fail- ure was approximately 26.67% （4/15）. Therefore, local failure is the main pattern of failure in esophageal cancer. Conclusion： The re- sults indicate that neoadjuvant chemotherapy with cisplatin and docetaxel followed by radiotherapy concurrent with weekly cisplatin for local

关 键 词：食管肿瘤放射疗法三维适形 同期放化疗 

分 类 号：R735.1[医药卫生—肿瘤]