同期放化疗模式下不同放疗剂量对局部晚期食管癌患者的疗效及安全性  

The efficacy and safety of concurrent radiotherapy and chemotherapy with different radiation doses in patients with locally advanced esophageal cancer

作　　者：李丹丹 亢崇照[1] 赵芳宗[1] 朱小娟[1] LI Dandan;KANG Chongzhao;ZHAO Fangzong;ZHU Xiaojuan(Department of Radiotherapy,the First Affiliated Hospital of He’nan University of Science and Technology,Luoyang 471000,He’nan,China)

机构地区：[1]河南科技大学第一附属医院放疗科,河南洛阳4710000

出　　处：《癌症进展》2020年第8期799-802,830,共5页Oncology Progress

摘　　要：目的探讨同期放化疗模式下不同放疗剂量对局部晚期食管癌患者的疗效及安全性。方法依据放疗剂量的不同将120例接受同期放化疗的局部晚期食管癌患者分为常规剂量组(n=68)和高剂量组(n=52),常规剂量组放疗剂量为50.4~54.0 Gy,高剂量组放疗剂量为60.0 Gy。比较两组患者的近期疗效、血清肿瘤标志物[血小板应答蛋白1(TSP1)和血管内皮生长因子(VEGF)]水平、远期疗效(3年、5年局部控制率和生存率)及不良反应发生情况。采用Cox回归模型分析食管癌患者预后的影响因素。结果常规剂量组患者的总有效率为51.47%,与高剂量组的55.77%比较,差异无统计学意义(P﹥0.05)。治疗前及治疗后,两组患者的血清TSP1、VEGF水平比较,差异均无统计学意义(P﹥0.05)。高剂量组患者的3年、5年局部控制率和生存率均高于常规剂量组,差异均有统计学意义(P﹤0.05)。两组患者2级及以上放射性食管炎、放射性肺炎、恶心呕吐的发生率比较,差异均无统计学意义(P﹥0.05)。Cox回归分析结果显示,同期放化疗模式下,放疗剂量、肿瘤部位、贫血程度均是食管癌患者预后的独立影响因素(P﹤0.05)。结论与常规剂量放疗联合同步化疗相比,高剂量(60.0 Gy)放疗联合同步化疗能够提高患者的远期疗效,且未增加不可逆致死性不良反应。Objective To explore the efficacy and safety of concurrent radiotherapy and chemotherapy with different radiation doses in the treatment of locally advanced esophageal cancer.Method A retrospective analysis including 120 patients with locally advanced esophageal cancer were included in the analysis as conventional dose group(n=68)and high dose group(n=52),receiving conventional radiation dose of 50.4-54.0 Gy or high radiation dose of 60.0 Gy,respectively.The short-term efficacy,levels of serum tumor markers[thrombospondin 1(TSP1)and vascular endothelial growth factor(VEGF)],long-term efficacy(3-year and 5-year local control rate and survival rate)and adverse reactions were compared between the two groups.Cox regression analysis was adopted to analyze the factors influencing the prognosis of esophageal cancer.Result The overall response rate in the conventional dose group and high dose group were51.47%and 55.77%,and no significant differences were observed(P>0.05);no significant differences with respect to TSP1 and VEGF levels were found between the two groups before and after treatment(P>0.05).The 3-year and 5-year local control rates and survival rates in the high dose group were significantly higher than those in conventional dose group(P<0.05).There was no significant differences with regard to the adverse reactions between the two group,including radiation-induced esophagitis,radiation-induced pneumonia,and nausea and vomiting of grade 2 or above(P>0.05).Cox regression analysis showed that radiation dose,tumor site and grade of anemia were independent prognostic factors for patients with esophageal cancer following the treatment pattern of concurrent chemotherapy and radiotherapy(P<0.05).Conclusion Compared with the conventional dose,high dose(60.0 Gy)of radiation therapy with concurrent chemotherapy may improve the long-term efficacy among patients with esophageal cancer,and may not increase the fatal adverse reactions.

关 键 词：同期放化疗 剂量 食管癌 疗效 局部控制率 生存率 

分 类 号：R735.1[医药卫生—肿瘤]