食管动脉灌注化疗联合放疗或手术切除治疗中晚期食管癌

目的评价经导管食管供血动脉灌注化疗(TAI)加放射治疗和TAI加手术切除治疗中晚期食管癌的效果和临床应用价值。方法经病理证实的食管鳞癌174例,包括单纯TAI治疗72例(对照组),行相应食管段肿瘤供血靶动脉选择性插管造影并灌注化疗药物;TAI治疗后加用放射治疗70例(TAI加放疗组)、TAI治疗后进行根治性手术切除32例(TAI加手术组),均先接受1~3次不等TAI治疗,再给予放射治疗(放疗剂量50~60Gy/5~6周)或手术切除治疗。结果对照组治疗后有效率(完全缓解 部分缓解)为83.3%(60/72),1、2、3、5年生存率分别87.5%、40.3%、20.8%、15.3%。TAI加放疗组治疗后有效率为95.7%(67/70),1、2、3、5年生存率分别为90.0%、72.9%、45.7%、37.1%。TAI加手术组1、2、3、5年生存率分别为96.9%、78.1%、50.0%、43.8%。近期有效率TAI加放疗组亦明显高于对照组(χ2=9.12,P<0.01)。患者2、3、5年中长期生存率TAI加放疗组和TAI加手术组明显优于对照组(χ2值分别为14.02、8.83、7.71和11.24、7.67、8.34,P值均<0.01),而TAI加放疗组与TAI加手术组间生存率后者高于前者,但无统计学差异(χ2值分别为0.64、0.10、0.04、0.17,P值均>0.05)。结果提示TAI结合放疗和手术切除疗效较好,明显提高了患者的中长期生存率。结论中晚期食管癌TAI结合放疗或结合手术切除联合治疗,较单一采用TAI治疗可明显提高患者疗效,是食管癌综合治疗可供选择的一种较佳联合模式和治疗途径。

Transcatheter arterial infusion chemotherapy combined with radiotherapy or surgery in the treatment of advanced esophageal carcinoma

Objective To investigate effect and clinical value of transcatheter arterial chemoinfusion (TAI) combined with radiotherapy or surgery in the treatment of advanced esophageal carcinoma. Methods Among 174 cases with pathalogically verified squamous carcinoma, 72 cases were treated with TAI (selective transcatheter arterial infusion chemotherapy),70 cases were treated with radiotherapy after TAI and 32 cases were treated with surgery after TAI. All cases were treated with TAI once or three times firstly, then radiotherapy or surgery was performed. Results The response rate in the control group was 83.3%(60/72) and the survival rate of one-year, two-year, three-year and five-year was 87.5%, 40.3%, 20.8% and 15.3%, respectively. In the group of combining TAI with radiotherapy, the response rate was 95.7% and the survival rate of one-year, two-year, three-year and five-year was 90.0%,72.9%, 45.7% and 37.1%, respectively. The survival rate of one-year, two-year, three-year and five-year in the group of TAI with surgery was 96.9%, 78.1% , 50.0% and 43.8%, respectively. The response rate of TAI with radiotherapy was higher than the rate in the control group (P<0.01). The survival rate of two-year, three-year and five-year in the group of TAI with radiotherapy and TAI with surgery were higher than the control (P<0.01). The survival rate of TAI with radiotherapy was lower than the rate of TAI with surgery, however no statistical significance was found (P>0.05). Conclusion Treating advanced esophageal carcinoma by combining TAI with radiotherapy or surgery is better than using TAI singly, which can improve the effect. It is a kind of better combined model in the treatment of esophageal cancer.