食管癌调强放疗不同治疗模式疗效比较  

Comparison of different treatment modalities in patients with esophageal carcinoma received intensi- ty-modulated radiotherapy

作　　者：王丽[1] 王祎[1] 王军[1] 曹峰[1] 景绍武[1] 焦文鹏 刘青[1] 杨从容[1] 

机构地区：[1]河北医科大学第四医院放疗科,石家庄050011

出　　处：《中国医师杂志》2016年第9期1320-1324,1328,共6页Journal of Chinese Physician

摘　　要：目的比较食管癌患者调强放疗不同治疗模式的长期疗效，分析治疗失败原因。方法食管癌调强放疗患者349例，采用放化综合治疗180例，其中同期放化疗121例，序贯放化疗59例；单纯放疗患者169例。观察不同治疗方法近期疗效、急性毒副反应及1、3、5年局部控制率及生存率，分析不同治疗模式对局控率及生存率的影响，观察治疗毒副作用，分析治疗失败原因。 结果调强放疗同期化疗组1、3、5年生存率分别为72.7%、46.0%和35.9%，序贯放化组分别为64.4%、35.1%和24.3%，单纯调强放疗分别为62.7%、36.1%和17.2%。同期放化组的1、3、5年生存率较单纯放疗组有显著提高（χ2＝5.631，P＝0.018）。调强放疗同期化疗组1、3、5年局控率分别为76.2%、67.3%和60.9%，序贯放化组分别为74.9%、49.2%和46.9%，单纯调强放疗分别为70.4%、59.7%和51.3%，三组局控率比较差异无统计学意义（χ2＝2.569，P＝0.277）。同期放化组、序贯放化组急性血液系统毒性反应发生率显著高于单纯放疗组（χ2＝42.550，P＝0.000），其中≥Ⅱ级骨髓抑制发生率同期放化疗组为47.9%（58/121），序贯放化疗组为42.4%（25/59），单纯放疗组为16.6%（28/169）。放化综合治疗组FP方案和TP方案局控率和生存率比较差异无统计学意义（χ2＝0.108，P＝0.742和χ2＝0.004，P＝0.948）。 结论食管癌调强放疗同期化疗长期生存率较单纯调强放疗显著提高，序贯放化疗与单纯放疗相比未见明显优势，不建议使用序贯放化疗模式。放化综合治疗较单纯放疗急性血液学毒性反应发生率显著增加。食管癌调强放疗联合化疗FP方案与TP方案疗效未见明显差异。ObjectiveTo investigate long-term efficacy in patients with esophageal carcinoma received different intensity-modulated radiotherapy （IMRT） modalities, and to analyze the reasons for treatment failure.MethodsA total of 349 esophageal cancer patients was analyzed in the study. The cases who underwent IMRT only, IMRT with concurrent chemotherapy and IMRT followed by sequential chemotherapy was 169 （48.4%）, 121 （34.7%）, and 59 （16.9%）, respectively. The short-term efficacy, acute toxicity, 1-, 3-, 5-year local control and survival rates in three different treatment strategy were evaluated. The effect of different treatment modalities on local control and survival was analyzed, meanwhile side-effects were observed, and treatment failure reason was also analyzed.ResultsThe 1-, 3- and 5-year survival rates were 72.7%, 46.0%, and 35.9% in concurrent chemoradiotherapy group, while 64.4%, 35.1%, and 24.3% in sequential chemoradiotherapy group, and 62.7%, 36.1%, and 17.2% in IMRT only group. The 1-, 3- and 5-year survival rates in concurrent chemo-radiotherapy were improved when compared to those in radiotherapy only （χ2=5.631, P=0.018）. The 1-, 3- and 5-year local controlled rates were 76.2%, 67.3%, and 60.9% in concurrent chemoradiotherapy group, 74.9%, 49.2%, and 46.9% in sequential chemoradiotherapy group, and 70.4%, 59.7%, and 51.3% in radiotherapy only group. There was no significant difference among three groups （χ2=2.569, P=0.277）. The acute rate of hematologic toxicity was increased when IMRT combined with chemotherapy versus radiotherapy only （χ2=42.550, P=0.000）. The bone marrow suppression rate ≥ grade II in concurrent chemoradiotherapy group was 47.9% （58/121）, and 42.4% （25/59） in sequential chemoradiotherapy group, and 16.6% （28/169） in radiotherapy only group It showed that FP regimen and TP regimen had the similar efficacy both in local control and suuvival （χ2=0.108, P=0.742; χ2=0.004, P=0.948）. ConclusionsComparing IMRT only group, the long-term surviva

关 键 词：食管肿瘤/放射疗法 放射疗法 调强适形/方法 

分 类 号：R735.1[医药卫生—肿瘤] R730.55[医药卫生—临床医学]