新辅助化疗治疗局部晚期食管鳞癌  

Clinical evaluations of neoadjuvant chemotherapy with DN and FP regimens for patients with middle or lower thoracic locally advanced esophageal squamous cell carcinoma

作　　者：杨洪霞[1] 姚娟[1] 温红[1] 于兰[1] 刘武[1] 梁华[1] 韩淑红[1] 

机构地区：[1]青岛市肿瘤医院放疗科,266042

出　　处：《中华医学杂志》2015年第19期1530-1533,共4页National Medical Journal of China

摘　　要：目的比较多西他赛＋顺铂（DN）、氟尿嘧啶＋顺铂（FP）方案新辅助治疗胸中下段局部晚期食管鳞癌的疗效和不良反应。方法2008年1月至2012年1月青岛市肿瘤医院124例经病理学证实的胸中下段局部晚期食管鳞癌，随机分为DN方案化疗组（DN组）和FP方案化疗组（FP组）。两组均行2周期新辅助化疗，化疗结束后3周检查评估行手术治疗。比较两组近期疗效、手术切除率、病理学变化、生存率和不良反应。结果DN组和FP组的2年总生存率、无瘤生存率、无局部、区域复发生存率及无远处转移率分别为71．1％和66．7％、65．0％和63．0％和78．3％和74．3％（均P〉0．05）。两组不良反应多为1—2级，其中DN组的白细胞减少发生率高于FP组（P〈0．05），而FP组的恶心、呕吐以及黏膜炎高于DN组（P〈0．05）。两组的化疗有效率、手术切除率、术后并发症、病理学变化均相似。DN组的术前降期率以及手术完全切除率高于FP组（P〈0．05）。结论多西他赛联合奈达铂新辅助治疗胸中下段局部晚期食管鳞癌手术切除率高，2年生存率较理想，不良反应可耐受，安全性好。Objective To explore the efficacies and side effects of neoadjuvant chemotherapy with DN （docetaxel plus cisplatin） and FP （nedaplatin plus cisplatin） regimens for patients with upper or middle thoracic locally advanced esophageal squamous cell carcinoma. Methods From January 2008 to January 2012, a total of 124 patients with upper or middle thoracic locally advanced esophageal squamous cell carcinoma were randomized into DN group （n = 64 ） and FP group （n = 60 ）. Both groups received neoadjuvant chemotherapy. The treatment schedule was recycled every 3 weeks. After 2 cycles, those with potential surgical resection underwent surgery. Results The 2-year overall, loeoregional relapse-free and distant metastasis-free survival rates in DN and FP groups were 71.1% and 66.7%, 65.0% and 63.0%, 78.3% and 74.3% respectively （P〉0. 05）. The incidence of leucopenia was higher in DN group than that in FP group （P 〈 0. 05 ）. And the occurrence rates of gastrointestinal toxicity and mucositis were significantly higher in FP group than those in DN group. No perioperative mortality occurred with a low incidence of postoperative complications. The rates of overall response, resection, postoperative complications and pathological complete rates response were similar in two groups. And the rates of downstage and R0 resection were significantly higher in DN group than those in FP group （ P 〈 0.05 ）. Conclusion For patients with middle or lower thoracic locally advanced esophageal squamous cell carcinoma, neoadjuvant chemotherapies of docetaxel and nedaplatin may achieve excellent outcomes in clinical response and 2-year survival rate. And the side effects are clinically acceptable.

关 键 词：食管肿瘤 肿瘤辅助疗法 外科手术 毒副作用 

分 类 号：R735.1[医药卫生—肿瘤]