后程加速超分割放疗联合奈达铂治疗老年食管癌的临床观察  

Clinical observation of late course accelerated hyperfractionated radiotherapy combined with nedaplatin chemotherapy for elderly patients with esophageal cancer

作　　者：罗宏涛[1,2] 魏世鸿[2] 康振朝 刘锐锋[2] 孙世龙[2] 刘小锋 祁月潇 董玉梅[2] 魏玺仪[2] 宋海侠[2] 郭丽云[2] 徐丽君[2] 王小虎[1,2] Luo Hongtao;Wei Shihong;Kang Zhenchao;Liu Ruifeng;Sun Shilong;Liu Xiaofeng;Qi Yuexiao;Dong Yumei;Wei Xiyi;Song Haixia;Guo Liyun;Xu Lijun;Wang Xiaohu(The First Clinical Medical College of Lanzhou University,Lanzhou 743019,China;Department of Radiotherapy,Gansu Tumor Hospital,Lanzhou 730050,China;Department of Radiotherapy,Liangzhou Hospital,Wuwei 733000,China)

机构地区：[1]兰州大学第一临床医学院,甘肃兰州743019 [2]甘肃省肿瘤医院放疗科,甘肃兰州730050 [3]武威市凉州医院放疗科,甘肃武威733000

出　　处：《实用肿瘤杂志》2019年第6期513-519,共7页Journal of Practical Oncology

基　　金：甘肃省科技支撑计划-社会发展类项目(1604FKCA109);兰州市人才创新创业项目(2017-RC-23)

摘　　要：目的观察后程加速超分割放疗(late course accelerated hyperfractionated radiotherapy,LCAHRT)联合奈达铂周化疗治疗老年食管癌的有效性及安全性。方法46例初治老年食管癌(≥70岁)患者按照随机数字表法分为LCAHRT组和LCAHRT同步化疗(LCAHRT plus concurrent chemotherapy,LCAHRT+C)组,各23例。LCAHRT组患者采用影像引导调强适形精确放疗治疗,6 MV-X线,4~5个共面或非共面适形照射野,前程肿瘤靶区(gross target volume,GTV)2.0 Gy/F,DT总量40 Gy/20 F;临床靶区(clinical target volume,CTV)1.8 Gy/F,DT总量36 Gy/20 F;后程加速超分割GTV 1.5 Gy/F,DT总量18 Gy/12 F,CTV 1.2 Gy/F,DT总量14.4 Gy/12 F;2 F/d,2次间隔>6 h。LCAHRT+C组在此基础上行同步单药奈达铂周化疗。随访7~47个月,比较两组之间的近期有效率、不良反应发生率、局部控制率、生存率及死亡原因差异。结果LCAHRT+C组与LCAHRT组完全缓解率(complete response,CR)分别为60.9%和30.4%(P=0.038),总有效率分别为87.0%和60.9%(P=0.044)。LCAHRT+C组恶心/呕吐、放射性食管炎和治疗后期体质量下降发生率均高于LCAHRT组(均P<0.05)。LCAHRT+C组与LCAHRT组中位局部控制时间分别为(23.5±10.2)个月和(18.0±10.6)个月(P<0.01),1、2和3年局部控制率分别为73.9%、60.8%、38.8%和56.2%、39.1%、17.4%(P=0.047),中位生存期分别为(25.6±9.3)个月和(19.6±10.2)个月(P=0.066),1、2和3年生存率分别为82.6%、60.9%、39.1%和65.2%、34.8%、21.7%(P=0.064)。全组共死亡32例,肿瘤局部复发进展为LCAHRT组的主要死亡原因,占比高于LCAHRT+C组(P=0.017),治疗相关不良反应所致的死亡占比LCAHRT+C组高于LCAHRT组(P=0.042)。结论LCAHRT同步奈达铂化疗治疗老年食管鳞癌近期疗效肯定,不良反应可耐受,局部控制率较单纯LCAHRT提高,但长期生存率无获益。Objective To investigate the efficacy and safety of late course accelerated hyperfractionated radiotherapy(LCAHRT)combined with nedaplatin chemotherapy for elderly patients with esophageal cancer.Methods Forty-six patients with newly diagnosed esophageal cancer(≥70 years old)were randomly assigned into the LCAHRT group and late course accelerated hyperfractionated radiotherapy plus concurrent chemotherapy(LCAHRT+C)group,each group with 23 patients.Patients in the LCAHRT group were treated with image-guided intensity-modulated conformal radiotherapy,with 6 MV-X ray,4 to 5 coplanar or non-coplanar conformal irradiation fields,first phrase conventional fractionation radiotherapy with gross target volume(GTV)2.0 Gy/F,total dose of tumor(DT)40 Gy/20 F;clinical target volume(CTV)1.8 Gy/F,total DT 36 Gy/20 F;and late course accelerated hyperfractionation with GTV 1.5 Gy/F,total DT 18 Gy/12 F,CTV 1.2 Gy/F,total DT14.4 Gy/12F,2 F/d,interval>6 h.While patients in the LCAHRT+C group received concurrent nedaplatin weekly chemotherapy on this basis.After 7-47 month follow-up,the short-term effective rate,adverse reactions,local control rate,survival rate and cause of death were compared between the two groups.Results The complete response(CR)in the LCAHRT+C and LCAHRT groups were 60.9%and 30.4%,respectively(P=0.038);the total effective rates[CR+partial response(PR)]of the two groups were 87.0%and 60.9%,respectively(P=0.044).The incidence of adverse reaction of nausea/vomiting,radiation esophagitis and post-treatment weight loss were higher in the LCAHRT+C group than those in the LCAHRT group(all P<0.05).The median local control time of the LCAHRT+C group and the LCAHRT group were(23.5±10.2)months and(18.0±10.6)months,respectively(P<0.01);the 1-,2-,and 3-year local control rates were 73.9%,60.8%,38.8%;and 56.2%,39.1%,17.4%,respectively(P=0.047).The median survival of the LCAHRT+C group and the LCAHRT group were(25.6±9.3)months and(19.6±10.2)months,respectively(P=0.066);and the 1-,2-,and 3-year survival rates were 82.6%,6

关 键 词：食管肿瘤/药物疗法 食管肿瘤/放射疗法 有机钳化合物/治疗应用 加速度 近距离放射疗法 存活率 综合疗法 治疗结果 随机对照试验 

分 类 号：R735.1[医药卫生—肿瘤] R730.53[医药卫生—临床医学]