三维适形放疗联合5-氟尿嘧啶、铂类化疗对食管鳞状细胞癌术后局部复发的疗效及生存率影响  

Efficacy and Survival Rate of Three-Dimensional Conformal Radiotherapy with 5-Fluorouracil and Platinum Based Chemotherapy for Postoperative Local Recurrence of Esophageal Squamous Cell Carcinoma

作　　者：李佩峰[1] LI Peifeng(Luohe Third People’s Hospital,Luohe,China,462000)

机构地区：[1]漯河市第三人民医院,河南漯河462000

出　　处：《食管疾病》2025年第1期42-47,52,共7页Journal of Esophageal Diseases

摘　　要：目的探究三维适形放疗(3D-CRT)联合5-氟尿嘧啶、铂类化疗对食管鳞癌(ESCC)根治性切除术后出现的局部复发治疗效果及对患者生存率的影响。方法回顾性分析利用3D-CRT(60 Gy,30次)联合5-氟尿嘧啶和铂类化疗的51例ESCC根治性切除术后,2~25个月内局部复发肿瘤患者,评判无进展生存期(PFS)、总生存期(OS)、不良事件发生率、OS单变量及多变量分析。结果治疗总缓解率为74.51%(38/51),完全缓解(CR)率为49.02%,中位PFS为8.2个月。中位OS为23.1个月,3 a的中位OS为40.71%。达到CR患者PFS高于非CR的患者,15.86%>4.73%;3 a的PFS率为49.01%,高于非CR患者4.23%(P<0.05)。CR患者的病程相较于非CR患者更长,3 a的OS率为CR患者62.54%,高于非CR患者的20.36%(P<0.05)。4级白细胞减少症、中性粒细胞减少症和血小板减少症,各出现2例(3.92%),3级疲劳出现9例(17.65%),3级白细胞减少症出现8例(15.69%),3级中性粒细胞减少症出现7例(13.73%),3级贫血和恶心均为4例(7.84%),3级低钠血症2例(3.92%),3级血小板减少症,发热性中性粒细胞减少、高血糖和肺炎均出现1例(1.96%)。单变量分析结果中,ECOG PS 0期、复发肿瘤最大横径<25 mm与OS显著性相关(P<0.05)。多变量分析结果表明,最长转移淋巴结肿瘤最大横径<25 mm是OS独立预后因素。结论对ESCC根除性手术后局部复发挽救性治疗方法采取3D-CRT联合5-氟尿嘧啶和铂类化疗,有效且安全,约40%患者在接受挽救治疗后获得了长期生存。Objective To investigate the therapeutic effect of three-dimensional conformal radiotherapy(3D-CRT)combined with 5-fluorouracil and platinum-based chemotherapy on local recurrence occurring after radical resection of esophageal squamous cell carcinoma(ESCC)and its impact on patient survival.Methods Retrospective analysis was conducted on 51 patients with locally recurrent tumors within 2-25 months after radical resection of ESCC treated with 3D-CRT(60 Gy,30 sessions)combined with 5-fluorouracil and platinum based chemotherapy.Progression free survival(PFS),overall survival(OS),incidence of adverse events were evaluated by univariate and multivariate analysis.Results The overall treatment remission rate was 74.51%(38/51),the complete response(CR)rate was 49.02%,the median PFS was 8.2 months.The median OS was 23.1 months and the 3 year median OS was 40.71%.The PFS in patients achieving CR was higher than that in non-CR patients,15.86%>4.73%;the 3 year PFS rate was 49.01%,higher than 4.23%in non-CR patients(P<0.05).The duration of the disease in patients with CR was longer than that in non-CR patients,with a 3 yearOS rate of 62.54%in CR patients,which is higher than the 20.36%in non CR patients(P<0.05).Grade 4 leukopenia,neutropenia,and thrombocytopenia were seen in 2 cases each(3.92%),grade 3 fatigue in 9 cases(17.65%),grade 3 leukopenia in 8 cases(15.69%),grade 3 neutropenia in 7 cases(13.73%),grade 3 anemia and nausea both in 4 cases(7.84%),grade 3 hyponatremia in 2 cases(3.92%),grade 3 thrombocytopenia,febrile neutropenia,hyperglycemia and pneumonia were present in 1 case(1.96%).In the results of univariate analysis,ECOG PS stage 0 and longest diameter of recurrent tumor<25 mm were significantly associated with OS(P<0.05).The results of multivariate analysis showed that the longest metastatic lymph node diameter<25 mm was an independent prognostic factor for OS.Conclusion The salvage treatment for local recurrence after ESCC radical surgery with 3D-CRT combined with 5-fluorouracil and platinum-based chemotherapy

关 键 词：三维适形放疗 食管鳞状细胞癌 局部复发 5-氟尿嘧啶 铂类 

分 类 号：R735.1[医药卫生—肿瘤]