食管癌术后放疗同步紫杉醇＋奈达铂方案化疗的初探  

Postoperative radiotherapy combined with concurrent paclitaxel-nedaplatin chemotherapy for esophageal cancer：a preliminary study

作　　者：康静静[1] 惠周光[2] 肖泽芬[1] 王小震[1] 梁军[1] 吕纪马[1] 周宗玫[1] 冯勤付[1] 陈东福[1] 张红星[1] 王绿化[1] 殷蔚柏 

机构地区：[1]国家癌症中心/中国医学科学院北京协和医学院肿瘤医院放疗科,北京100021 [2]国家癌症中心/中国医学科学院北京协和医学院特需医疗部,北京100021

出　　处：《中华放射肿瘤学杂志》2016年第6期571-575,共5页Chinese Journal of Radiation Oncology

基　　金：基金项目：国家自然科学基金项目（81372418）

摘　　要：目的 评估食管鳞癌术后IMRT同步紫杉醇＋奈达铂每周方案化疗的安全性和初步疗效。方法 2010—2013年共52例患者入组。IMRT临床靶区包括瘤床＋相应高危淋巴引流区,放疗总剂量为50~60 Gy,2.0 Gy/次,5 次/周;同步化疗奈达铂25 mg/m2第1天＋紫杉醇45~50 mg/m2第1天,放疗期间每周重复。不良反应评价采用CTCAE 4.0标准,采用Kaplan-Meier法生存分析。结果患者治疗耐受性较好,51例（98%）按既定方案完成放疗,化疗中位周期数为4个,42例（81%）完成≥3周化疗;不良反应以1—2级为主,3级主要为白细胞下降（29%）、放射性食管炎（10%）和吻合口狭窄（4%）,1例患者（2%）出现5级消化道出血。全组患者中位生存时间为38.7个月,1、2、3、4年OS率分别为83%、64%、51%和38%。总复发率为46%,其中LRR率为15%,DM率为37%。结论 食管鳞癌术后IMRT同步紫杉醇＋奈达铂每周方案化疗安全有效,值得开展大规模前瞻性随机分组研究。Objective To investigate the safety and preliminary effect of postoperative intensity-modulated radiotherapy （IMRT） combined with concurrent weekly paclitaxel-nedaplatin chemotherapy for patients with esophageal squamous cell carcinoma. Methods A total of 52 patients who were treated from 2010 to 2013 were enrolled. The clinical target volume of IMRT included tumor beds and corresponding lymphatic drainage regions at high risk, and the total radiotherapy dose was 50-60 Gy, 2.0 Gy/fraction, 5 fractions per week. The concurrent chemotherapy consisted of nedaplatin 25 mg/m2 on D1 and paclitaxel 45-50 mg/m2 on D1 and was repeated every week during radiotherapy. Common Terminology Criteria for Adverse Events 4.0 was used to evaluate adverse events, and the Kaplan-Meier method was used for survival analysis. Results All the patients had good tolerance to the treatment, and 51 patients （98%） completed radiotherapy according to the scheduled regimen. The median number of chemotherapy cycles was 4, and 42 patients （81%） completed ≥3 cycles of chemotherapy. Most adverse events were of grade 1-2, and grade 3 adverse events were leucopenia （29%）, radiation esophagitis （10%）, and anastomotic stenosis （4%）. One patient （2%） experienced grade 5 gastroesophageal bleeding. Of all the patients, the median survival time was 38.7 months, and the 1-, 2-, 3-, and 4-year overall survival rates were 83%, 64%, 51%, and 38%, respectively. The overall recurrence rate was 46.2%, and the locoregional recurrence rate and distant metastasis rate were 15% and 37%, respectively. Conclusions Postoperative IMRT combined with concurrent weekly paclitaxel-nedaplatin chemotherapy for patients with esophageal squamous cell carcinoma is safe and effective, and large-scale prospective randomized studies are needed.

关 键 词：食管肿瘤/放化疗法 放化疗法 同步 疗效 安全性 

分 类 号：R735.1[医药卫生—肿瘤]