周低剂量紫杉醇同步放疗治疗局部晚期食管癌的疗效

目的 探讨周低剂量紫杉醇同步放疗与周期性化疗同步放疗治疗局部中晚期食管癌的临床疗效及毒副反应.方法 将70例局部晚期食管癌患者随机分成两组,周低剂量紫杉醇同步放疗组(观察组,35例)采用紫杉醇(30 mg·m-2·w-1)静脉滴注,放疗第1天给药,持续6w;周期性化疗同步放疗组(对照组,35例)采用紫杉醇联合顺铂(紫杉醇135 mg/m2,第1天,顺铂20 mg/m2,第1～5天,21 d为1个周期,共2个周期),两组均采用23EX直线加速器三维适形同步放疗.比较治疗后两组近期疗效、毒副反应及2年生存率.结果 观察组与对照组总有效率有统计学差异(P＜0.05);两组的远处转移率和2年生存率之间无统计学差异(P＞0.05).观察组Ⅲ、Ⅳ度骨髓抑制和放射性食管炎的发生率优于对照组(P＜0.05),Ⅰ、Ⅱ度骨髓抑制无统计学差异(P＞0.05).结论 周低剂量紫杉醇同步放疗对比周期性化疗同步放疗治疗局部晚期食管癌能明显提高疗效,且能降低毒副反应.     

三维适形放疗联合紫杉醇、奈达铂同步化疗治疗局部晚期食管癌的临床观察

目的观察三维适形放疗联合紫杉醇、奈达铂同步化疗治疗局部晚期食管的近期疗效及不良反应。方法 2013年1月~2015年5月我院放疗科收治的41例局部晚期食管癌患者随机分为单纯三维适形放疗组(单纯放疗组)和三维适形放疗联合紫杉醇、奈达铂化疗组(同步放化疗组)。放疗第一天开始行TN方案(紫杉醇60 mg/m2D1、D8,奈达铂40 mg/m2D1、D8,21天为一周期,放化疗期间化疗1~2周期,放疗结束后继续2个周期化疗)。结果放疗结束后3个月,同期放化疗组与单纯放疗组的临床有效率分别为90.0%和61.9%,差异有统计学意义(P0.05),两组1年生存率分别为85%和47.6%,差异有统计学意义(P0.05)。同期放化疗组骨髓抑制较单纯放疗组明显,两组差异有统计学意义(P0.05)。结论对局部晚期食管癌的患者进行三维适形放疗联合紫杉醇、奈达铂同步化疗的治疗方法能够收到较好的治疗效果。虽不良反应增加,但可以耐受。     

调强放疗联合PC方案化疗治疗局部晚期肺腺癌疗效观察

目的 观察调强放疗联合PC方案化疗治疗局部晚期肺腺癌的疗效.方法 46例局部晚期肺腺癌患者,随机分为P组和E组,各23例.P组采用调强放疗联合培美曲赛+顺铂(PC方案)同步化疗,E组采用调强放疗联合依托泊苷+顺铂(EP方案)同步化疗.P组方案:培美曲赛500 mg/m2、顺铂75 mg/m2第1天静滴,21 d重复.E组方案:顺铂50 mg/m2第1、8天静滴;依托泊苷50 mg/d,第1～5天静滴,28 d重复.每组放疗剂量60 Gy/30次,放疗期间共化疗2周期,化疗共维持4周期.观察并比较两组患者近期疗效、1年生存率和不良反应发生情况.结果 所有患者均完成治疗计划.P组总有效率(CR+ PR)78.3％,E组总有效率69.6％,两组相比,P＜0.05.两组均无治疗相关死亡病例.P组和E组中位疾病无进展时间分别为8.6和6.9个月(P＜0.05).P组和E组1年生存率分别为82.6％和78.3％(P＞0.05);两组不良反应以Ⅰ～Ⅱ级反应为主,只有少数Ⅲ级反应者.结论 调强放疗联合PC方案化疗治疗局部晚期肺腺癌疗效优于调强放疗联合EP方案化疗.     

局部晚期食管癌同步放化疗和序贯放化疗的临床分析

目的观察三维适形放疗联合PF方案同步及序贯治疗局部晚期食管癌的疗效和毒副反应。方法 64例局部晚期食管癌患者随机分为两组,给予化疗用药氟尿嘧啶1 000 mg/m2,第1～5天静滴,顺铂75 mg/m2,第1～5天静滴,28 d为1个周期,并分别行同步、序贯三维适形放疗。结果同步组与序贯组总有效率分别为91.18%和70.00%(χ2=4.69,P<0.05)1,年生存率分别为79.41%和60.00%(χ2=2.88,P>0.05)2,年生存率分别52.94%和30.00%(χ2=3.44,P>0.05),治疗所需的总时间两组比较有统计学差异(P<0.05)。毒副反应主要表现为放射性食管炎、血液毒性和恶心呕吐,两组比较仅血液毒性有统计学差异(P<0.05),发生率分别为26.47%和16.33%。结论 PF方案联合同步或序贯三维适形放疗疗法是治疗局部晚期食管癌安全、有效的治疗手段,同步组使治疗总疗程缩短,虽毒性作用增加,但患者均能耐受,有进一步研究的价值。     

PF方案联合放疗治疗局部晚期食管癌61例疗效观察

对61例局部晚期食管癌患者采用同时放化疗治疗，化疗方案：5-Fu 750mg／d，静滴第1～5天；顺铂20mg／d，静滴第1～5天。21d为一周期，共用2个周期。化疗第1天行常规分割放疗，放疗剂量为60-70Gy，2Gy／次。结果61例患者均完成治疗，总有效率为67．2％，其中CR占16．4％，2a生存率为31．1％，无4级以上毒性反应。认为同时放化疗治疗可用于局部晚期食管癌的治疗。     

改良同期放化疗联合辅助化疗治疗局部晚期鼻咽癌临床观察

目的探讨改良同期放化疗联合辅助化疗治疗局部晚期鼻咽癌的疗效。方法将70例Ⅲ、Ⅳa期鼻咽癌患者随机分为观察组和对照组各35例。两组放疗方案均采用常规分割放疗,对照组不使用化疗。观察组同期化疗于放疗第1周开始,顺铂80 mg/m2,第1~3天,28 d为1个周期,共2个周期;辅助化疗于放疗结束后1个月开始,使用PF方案,顺铂80 mg/m2,第1~3天,5-FU 1 000 mg/m2,第1~3天,28 d为1个周期,共3个周期。结果观察组完成5个周期化疗的患者为27例（77.1%）,完成2个周期的同期化疗患者为31例（88.6%）,接受3个周期的辅助化疗患者为28例（80.0%）。观察组1、2、3年生存率分别为100%、94.3%、88.4%,对照组分别为97.1%、77.1%、70.6%,两组相比,P均〈0.05。观察组Ⅲ度口腔黏膜炎发生率为77.1%,对照组为37.1%;观察组Ⅰ、Ⅱ度白细胞下降发生率为71.4%,对照组为8.6%,两组相比,P均〈0.05。结论改良同期放化疗联合辅助化疗治疗局部晚期鼻咽癌患者依从性较高,不良反应可以耐受,近期疗效较好。     

同期放化疗治疗局部晚期鼻咽癌临床观察

目的观察同期放化疗治疗局部晚期鼻咽癌（NPC）的临床疗效。方法将100例局部晚期NPC患者随机分为两组各50例,对照组采用单纯放疗;治疗组在放疗第1、4周加行2个周期的顺铂加5-氟尿嘧啶方案化疗。结果与对照组比较,治疗组完全缓解率高,1、3 a生存率高,急性黏膜损伤率高,局部复发率及3 a远处转移率低（P均〈0.05）。结论同期放化疗可降低局部晚期NPC患者的远处转移率,提高其3 a生存率,且毒副反应可以耐受,值得临床推广。     

动脉灌注诱导化疗联合同期放化疗治疗局部晚期鼻咽癌的疗效

目的探讨动脉灌注诱导化疗联合同期放化疗治疗局部晚期鼻咽癌的临床效果。方法收集2009年1月至2013年6月该院100例首次治疗局部晚期(T3T4/N2N3)鼻咽癌患者,前瞻性随机对照研究,随机分为试验组和对照组各50例,试验组(IAC组,动脉灌注诱导化疗联合后期同步放化疗):先用多西他赛60⁷5 mg/m2d1+顺铂75 mg/m2d1,动脉灌注给药,21 d为1个周期,连续使用2个周期,再予以根治性放疗,TD40 Gy时开始同步放化疗,顺铂40 mg/m2d1,动脉灌注给药,1次/w,直至放疗结束;对照组(IVC组,经静脉诱导化疗联合放疗):诱导化疗方案同IAC组,静脉给药。两组放疗剂量及放疗时间相仿。用Kaplan-Meier及Log-rank法计算并比较两组患者的生存率。结果治疗结束后观察3个月,IAC组完全缓解率(CR)明显高于IVC组(P<0.05);与IVC组相比,IAC组3年及5年总生存率(OS)、无局部复发生存率(LRFS)、无病生存率(DFS)明显更高(均P<0.05);两组3年及5年无远处转移生存率(DMFS)、急性毒副反应及远期并发症发生率相仿(均P>0.05)。结论 IAC组与IVC组相比,显著提高近期CR率、LRFS及DFS,有提高OS的趋势,未增加近期毒副反应及远期并发症,值得进一步扩大病例数研究。     

三维适形放疗同步化疗治疗中晚期食管癌的疗效与安全性观察

目的观察三维适形放疗同步化疗治疗中晚期食管癌的疗效与安全性。方法选择67例不能手术的食管癌患者,采用三维适形放射治疗（3D-CRT）同步化疗,化疗先采用DP方案：多西紫杉醇75mg／m^2,第1天;顺铂40mg／m^2,第1、2、3天,21d为一周期,共化疗2个周期,放疗结束后继续化疗4个周期。放疗从第1天开始,DT60-66Gy,分30～33次进行,6～6．5周完成。结果完全缓解39例,部分缓解22例,有效率91．0％;1、2、38局部控制率分别为80．5％、73．1％、46．2％;1、2、3a生存率分别为83．5％、77．6％、52．2％。毒副反应主要为白细胞下降、血小板下降和放射性食管炎,均以Ⅰ-Ⅱ度为主;放射性肺炎发生率较低,且均为Ⅰ-Ⅱ度。结论采用DP方案化疗同步3D-CRT治疗食管癌的近期疗效和局部控制率较好,可以提高患者生存率,虽然毒副反应增加,但患者基本可以耐受。     

奈达铂化疗同步三维适形放疗治疗中晚期食管癌的临床观察

背景:食管癌常规放疗疗效欠佳,局部复发常见。目的:探讨奈达铂(NDP)化疗同步三维适形放疗治疗中晚期食管癌的疗效和毒副反应。方法:75例经病理证实的中晚期食管癌患者随机分成放疗组(37例,6 MV-X线或15 MV-X线常规放疗,2.0 Gy/次,5次/周,6～7周)和同期放化疗组(38例,与放疗同步行NDP化疗,30～40 mg静脉滴入,1次/周,共6次)。治疗结束后3个月评估近期疗效和近期毒副反应,随访结束后评估远期疗效。结果:同期放化疗组的总有效率高于放疗组,差异有统计学意义(78.9%对514%,P0.05);放疗组和同期放化疗组的2级及以上、3级及以上放射性食管炎发生率差异无统计学意义(40.5%对50.0%,10.8%对18.4%,P0.05)。同期放化疗组的1、3年局部控制率(73.0%对63.6%,49.2%对43.3%,P0.05)和1、3年生存率(69.8%对49.8%,41.3%对30.2%,P0.05)均显著高于放疗组。结论:NDP化疗同步放疗治疗中晚期食管癌的近、远期疗效均优于单纯放疗,且患者能耐受近期毒副反应,因此具有一定临床应用前景。     

紫杉醇或5-氟尿嘧啶联合顺铂同步放疗方案治疗老年中晚期食管癌患者的临床效果及安全性

目的 比较紫杉醇或5-氟尿嘧啶联合顺铂同步放疗方案治疗老年中晚期食管癌患者的效果及安全性。方法 选择2016年5月至2018年6月在新疆生产建设兵团医院进行治疗的102例老年中晚期食管癌患者为研究对象,将患者随机分为紫杉醇组(n=52)和5-氟尿嘧啶组(n=50)。比较2组患者的治疗效果、2年生存率、胃肠道副反应、肝肾功能损伤及骨髓抑制情况。采用SPSS 25.0统计软件进行数据分析。分类资料采用χ²检验和Fisher精确检验,临床疗效及安全性评价采用Kaplan-Meier分析和Log-rank检验。结果 紫杉醇组和5-氟尿嘧啶组治疗有效率分别为65.38%(34/52)和62.00%(31/50),差异无统计学意义(P＞0.05);控制率分别为94.23%(49/52)和70.00%(35/50),差异有统计学意义(P=0.032);2年生存率差异无统计学意义(P＞0.05)。紫杉醇组患者恶心呕吐和骨髓抑制的发生率分别为40.38%(21/52)和67.31%(35/52),与5-氟尿嘧啶组的74.00%(37/50)和28.00%(14/50)比较,差异均有统计学意义(P＜0.05);肝、肾功能损伤的发生率差异无统计学意义(P＞0.05)。结论 紫杉醇联合顺铂同步放疗方案治疗老年中晚期食管癌患者的疗效与5-氟尿嘧啶联用顺铂同步放疗相近,且不易引起胃肠道不良反应和骨髓抑制。     

The intergroup/RTOG 85-01 concurrent chemoradiation regimen for Japanese esophageal cancer

BACKGROUND/AIMS: To evaluate outcome of the U.S. RTOG/Intergroup Protocol 85-01 for 44 Japanese esophageal cancer patients. Methodology: Between 1996 and 2004, patients with esophageal cancer received the Intergroup concurrent chemoradiation therapy regimen for the primary treatment (n=44, group A). We compared the data with those of patients receiving radiotherapy (RT) combined with the weekly chemotherapy regimen (n=12, group B) and with those of patients receiving RT combined with the daily low-dose chemotherapy regimen (n=24, group C). RESULTS: The median survival period was 14.9 months in group A, 5.7 months in group B, and 6.3 months in group C. The survival rates at 1 and 3 years were 56% and 26% in group A, 42% and 21% in group B (p=0.3307), and 27% and 18% in group C (p=0.0462), respectively. CONCLUSIONS: The prognosis of patients who received the Intergroup regimen for esophageal cancer was significantly better than that of patients who received the daily low-dose chemotherapy regimen. The Intergroup regimen is well tolerable for the Japanese patients too.     

盖诺联合放疗治疗晚期非小细胞肺癌的临床研究

目的　观察以盖诺加顺铂联合放疗治疗晚期非小细胞肺癌的临床疗效及毒副作用。方法　 38例晚期非小细胞肺癌患者接受盖诺加顺铂方案联合放疗 ,与同期单纯接受化疗的 36例对比。结果　客观近期有效率 ,中位生存期和 1年、2年、3年生存率 :放化疗组分别为 6 5 .8% ,14个月和 6 3.1%、39.4 %、2 8.9% ;而化疗组为 4 4 .4 % ,11个月和 4 1.6 %、2 7.7%、11.1% ,两组近期有效率有显著性差异 (P<0 .0 5 )。毒副作用可耐受 ,无治疗相关性死亡。结论　以盖诺加顺铂联合放疗治疗晚期非小细胞肺癌有效率较高 ,安全性较好的综合治疗方案 ,值得采用。     

Busulfan and cyclophosphamide as a preparative regimen for bone marrow transplantation in patients with prior chest radiotherapy

In a previous study, we reported that patients with hematologic malignancies who had received prior chest radiotherapy had a 32% risk of developing fatal interstitial pneumonia (IP) when prepared for bone marrow transplantation (BMT) with a regimen containing total body irradiation (TBI). To determine if avoidance of TBI would lessen the incidence of fatal IP, 37 patients who had received prior chest radiotherapy in excess of 2000 cGy were prepared with busulfan (BU, 4 mg/kg x 4 days) and cyclophosphamide (CY, 60 mg/kg x 2 days) followed by autologous (n = 15) or allogeneic (n = 22) BMT. Thirty-five of these patients had recurrent or refractory hematologic malignancies and most were heavily pretreated. Results were compared with the group of similar patients (n = 25) previously treated at our institution with a CY/TBI conditioning regimen. Among those treated with BU/CY, two patients (5%) developed fatal interstitial pneumonia, 12 (32%) died of other transplant related toxicities and 13 (35%) died of relapse. Seven (19%) patients remain alive and well. Among those treated with CY/TBI, eight (32%) died of pneumonia, six (24%) died of relapse, nine (36%) died of other causes and two (8%) remain alive and well. The 5% incidence of fatal interstitial pneumonitis in the chemotherapy conditioned group was significantly less than the 32% incidence in the previously treated CY/TBI group (p = 0.005). However, long-term survival and relapse probabilities were not significantly better than seen previously with CY/TBI, although a trend towards improved survival was observed in the BU/CY group. Avoidance of TBI appeared to lower the incidence of fatal pneumonitis in patients with prior chest radiotherapy.     

Expandable metal stents versus laser combined with radiotherapy for palliation of unresectable esophageal cancer: a prospective randomized trial

BACKGROUND/AIMS: Because of the short life expectancy of patients with esophageal cancer, relief of dysphagia associated with low morbidity and mortality must be the aim of any therapeutic strategy. METHODOLOGY: A total of 39 patients with unresectable esophageal cancer were randomly allocated to either receive combined laser-percutaneous radiotherapy (group 1, n = 21) or to have a self-expanding metal stent placed (group 2, n = 18). Some patients in group 2 required initial laser therapy (group 2a, n = 8). Treatment efficacy was evaluated on the basis of improved dysphagia, restenosis, hospital stay, survival time and costs. RESULTS: Both treatments were able to significantly improve dysphagia. Restenosis occurred in 43% of group 1 and 22% of group 2 patients. In group 1, 2 patients had severe bleeding episodes and 2 patients developed esophago-tracheal fistulas. One group 1 patient died due to uncontrollable bleeding and 1 patient to recurrent aspiration. No treatment-related death was observed in group 2. Hospital stay was 30.0 (mean: 5.4) days in group 1, 18.9 (mean: 4.2) days in group 2a and 7.1 (mean: 3.1) days in group 2b. There was no statistical difference between the 3 groups with regard to survival. Costs were highest in group 1 and lowest in group 2b. CONCLUSIONS: The treatment of unresectable esophageal cancer with self-expanding metal stents appears to be simple, safe, as good as laser combined with radiotherapy and cost efficient.     

新辅助放化疗对中晚期食管鳞癌病理分期及预后的影响

目的:评估新辅助放化疗对中晚期食管鳞癌病理分期及预后的影响。方法:1991-01/2000-12中晚期食管鳞癌患者473例,随机分为4组,新辅助放疗组(n= 118)、新辅助化疗组(n=119)、新辅助放化疗组(n=118)及对照组(单纯手术)(n=118),统计分析4组在切除率、病理分期、并发症、生存期等方面的差别结果:放疗组、化疗组、放化组与对照组相比均可提高根治性切除率(97.5%,86.6%,98.3% vs 73.7%,均P<0.01);放疗组、放化组与对照组相比有明显降期作用(P<0.01);而化疗组没有明显降期作用.放疗组、化疗组、放化组与对照组相比,手术并发症无明显增加(P>0.05),放疗组、放化组的3a生存率相比对照组显著提高(69.5%,73.7% vs 53.4%,均P<0.01).放化组的5a生存率优于放疗组,但无统计学意义(45.O% vs 40.7%,P>0.05).结论:合理应用新辅助放化疗可提高中晚期食管鳞癌患者生存期并提高其生存质量.     

Radiation therapy combined with cis-diammine-glycolatoplatinum (nedaplatin) and 5-fluorouracil for Japanese stage II–IV esophageal cancer compared with cisplatin plus 5-fluorouracil regimen: a retrospective study

To evaluate the treatment outcome of radiotherapy combined with cis-diammine-glycolatoplatinum (nedaplatin) plus 5-fluorouracil (5-FU) for esophageal cancer. From January 2000 to December 2004, a total of 12 esophageal cancer patients with locally advanced and metastatic esophageal cancer (stages II-IVB) were treated with radiation therapy (50.4 Gy) combined with nedaplatin (80 mg/m(2), bolus infusion) and 5-FU (800 mg/m(2)/24 h, continuous infusion for 4 days) (NDP group). We compared the data with those of patients during the same period receiving a different chemotherapy regimen consisting of cisplatin (75 mg/m(2), bolus infusion) and 5-FU (1000 mg/m(2)/24 h, continuous infusion for 4 days) (n = 29, CDDP group) combined with the same radiation therapy. The median survival period was 11.5 months in the NDP group and 13.1 months in the CDDP group. The overall survival rates at 1-, 2-, and 3-years were 40%, 13%, and 13% in the NDP group and 56%, 42%, and 8% in the CDDP group (P = 0.2472), respectively. Grade III and IV leukocytopenia was observed in six (50%) and none of the patients in the NDP group and 14 (48%) and seven (24%) in the CDDP group, respectively. Grade III thrombocytopenia was observed in three (25%) in the NDP group and four (14%) in the CDDP group. Radiation combined with nedaplatin and 5-FU is a safe and effective method for treating esophageal cancer. We recommend that NDP should be used rather than dose-reduction of CDDP combined with 5-FU in patients with impaired renal function as indicated by low creatinine clearance value (40-60 mL/min).     

Esophagectomy for locally advanced esophageal cancer, followed by chemoradiotherapy and adjuvant chemotherapy

AIM: To compare the efficacy and toxicity of a three-step combination therapy with post-operative radiation alone for locally advanced esophageal cancer. METHODS: Patients with T3-4 and NO-1 esophageal carcinoma from a number of institutions were non-randomly, prospectively enrolled in the study. All patients underwent single-stage curative en bloc esophagectomy. The patients were then assigned into one of two treatment groups based on treatment consisting of either post-operative concurrent chemoradiotherapy (CCRT) with weekly cisplatin 30 mg/m~2 followed by systemic adjuvant chemotherapy (four monthly cycles of cisplatin 20 mg/m~2 and 5-fluorouracil 1000 mg/m~2 for five consecutive days), or, post-operative radiation alone. The radiotherapy dose was 55-60 Gy for all patients. Primary end-point of this study was to assess the per-protocol patients' improvement of overall survival benefit. Secondary end-point was designed to evaluate both the per-protocol and intent-totreat patients' outcome of survival. RESULTS: A total of 60 patients (n=30 per group) were enrolled in this study. The two groups were generally comparable for demographic characteristics and hematologicai and non-hematological toxicities. The CCRT with weekly cisplatin was well tolerated, with significantly better overall survival (30.9 mo vs 20.7 mo; 95% CI, 27.5-36.4 vs 15.2-26.1) and 3-year survival (70.0% vs 33.7%; P=0.003). Low histological grade of tumor (P<0.001) was associated with favorable survival in these locally advanced patients. CONCLUSION: For locally advanced esophageal cancer, the combination of esophagectomy, post-operative CCRT with weekly cisplatin and systemic adjuvant chemotherapy is well tolerated and effective. A large-scale, prospective randomized trial of this regimen is in progress.     

Effect of chemoradiotherapy for neural invasion in an advanced esophageal cancer

BACKGROUND/AIMS: For esophageal cancer, the incidence of lymphatic, local, and hematogenous recurrence is high, and prognosis is poor. This study examined utility of chemoradiotherapy for neural invasion, a risk factor for local recurrence, and a poor prognosis factor. METHODOLOGY: Neural invasion was studied histochemically in 183 patients with resected advanced esophageal squamous cell carcinoma, of T2 or greater depth of wall invasion. RESULTS: Neural invasion positivity occurred in 78 of 183 (46.2%) patients, 11 of 21 (52.4%) of the preoperative radiotherapy alone group, and 5 of 22 (22.7%) in the preoperative chemoradiotherapy group (p<0.05). The local recurrence rate overall was 15.0% in the preoperative radiotherapy alone group compared to 5.9% in the chemoradiotherapy group. CONCLUSIONS: Chemoradiotherapy is effective for neural invasion in comparison with radiotherapy alone.     

二甲双胍对糖尿病合并食管癌患者放疗效果分析

目的通过观察二甲双胍对糖尿病合并食管癌患者放疗效果,为糖尿病合并食管癌患者的治疗提供依据。方法选取2016年-2018年在该院确诊的糖尿病合并食管癌并口服二甲双胍降糖治疗的患者51例为观察组,同期诊断糖尿病合并食管癌并皮下注射胰岛素治疗的患者50例为对照组,所有的患者均实施内镜切除联合局部放疗治疗。治疗结束后随访1个月,根据RECIST标准对治疗效果进行评价两组患者的近期疗效。结果观察组患者近期疗效明显优于对照组(P<0.05)。结论二甲双胍可以提高食管癌患者的放疗效果。