三维适形放疗同期DDP+5-FU方案化疗治疗食管癌疗效观察

目的观察三维适形放疗同期DDP+5-FU方案化疗对食管鳞癌的疗效,及近期和远期毒性。方法44例符合标准的食管鳞癌,应用随机法分为同期放化疗组22例(放化组)和单纯适形放疗组22例(单放组)。放化组全程适形常规分割照射,6周完成,每天1次,每次2.0 Gy,每周5次,30分割,总剂量60 Gy。同期化疗开始于放疗的第1天,采用DF方案,每28天重复,共2周期。单放组三维适形放疗总剂量60 Gy,总治疗时间6周,同放化疗组。结果1年局控率放化组显著性优于单放组,P=0.014;而1年无远地转移率和1年总生存率无差异。同期放化疗的急性反应主要是放射性食管炎、放射性肺炎、血液学毒性、恶心呕吐和厌食,大部分较轻微易于临床处理。食管和肺晚期反应并不多见,除1例Ⅳ级食管反应外,其余均为I、II级。结论同期放化疗较单纯适形放疗显著提高了局控率,显示了提高总生存率的趋势,而未能显著性减少远地转移率。其近期和远期毒性可以耐受。

An Analysis of Treatment Effectiveness of Conformal Radiotherapy Combined with Chemotherapy for Esophageal Carcinoma

Objective To estimate the effect of conformal radiotherapy plus cisplatin with 5 - flurouracil concurrent chemoradiotherapy of esophageal cancer and to observe the acute and late toxicities. Methods Forty -four patients with esophageal squamous carcinoma were randomized into two groups with delamination block randomized method ：22 cases in conformal radiotherapy plus concurrent chemotherapy （RCT）and 22 cases in only conformal radiotherapy （CRT）. Radiotherapy in RCT group was performed with conventional fractionation on the first day of week 1. Results Only the 1 - year local control rate of RCT group was significantly better than that of CRT group. The major acute toxicities in RCT group were radiation - induced esophagitis, radiation - induced pneumonia, myelosuppression, nausea and vomiting and anorexia. Most of them were slight to moderate and manageable. The late toxicities of esophagus and lung were rare and slight exception of one case late radiation - in- duced grade V toxicity of esophagus. Conclusion RCT improved the local control rate significantly and showed the improved tendency of survival rate compared with CRT. The non - metastasis rate was not improved significantly. The acute and late toxicities of RCT were manageable.