胸段食管鳞癌术前同步放化疗不同放疗分割方式的临床研究

目的 评价术前大分割放疗与常规分割放疗治疗胸段食管鳞癌的疗效和安全性。方法 2002—2011年四川省肿瘤医院收治的行术前放化疗的胸段食管鳞癌共86例,根据术前放疗分割方式分为大分割放疗组(A组,41例,30 Gy分10次2周)和常规分割放疗组(B组,45例,40 Gy分20次4周),放疗结束后2—6周手术。Kaplan-Meier法计算生存并Logrank检验。结果 A组与B组病理降期率分别为68%和56%(P=0.270),R0切除率分别为95%和89%(P=0.437),pCR率分别为32%和24%(P=0.480)。A组和B组1、3、5年OS分别为78%和69%、44%和44%,29%和33%(P=0.114、0.223、0.289),PFS分别为71%和62%、39%和38%、24%和29%(P=0.211、0.689、0.331)。两组患者放化疗和手术相关不良反应相近(P=0.089~0.872)。大分割放疗组在平均住院天数、放疗费用及术前治疗总费用上均明显低于常规放疗组(P=0.000、0.000、0.000)。结论 术前大分割放疗和常规放疗均可作为可切除胸段食管鳞癌术前放疗的选择方案。术前大分割放疗有治疗周期和住院时间短,放疗费用低,患者更易接受的优势。

Different fractionation schedules of radiotherapy in preoperative concurrent chemoradiotherapy for thoracic esophageal cancer:a clinical study

Objective To investigate the clinical efficacy and safety of preoperative hypofractionated and conventionally-fractionated chemoradiotherapy for thoracic esophageal cancer. Methods A total of 86 patients with thoracic esophageal cancer receiving chemoradiotherpy in Sichuan Cancer Hospital between 2002 and 2011 were enrolled and randomized into the preoperative hypofractionated chemoradiotherapy group (group A, n=41,30 Gy in 10 fractions for 2 weeks) and conventionally-fractionated chemoradiotherapy group (group B, n=45,40 Gy in 20 fractions for 4 weeks). Surgery was performed at 2-6 weeks after chemoradiotherapy. The probability of patients’ survival was estimated by Kaplan-Meier method and analyzed by log-rank test. Results In groups A and B, the pathological downstaging rates were 68% and 56%(P=0.270), the R0 resection rates were 95% and 89%(P=0.437) and the pCR rates of 32% and 24%(P=0.480).The 1-,3-and 5-year overall survival (OS) rates were 78% and 69%,44% and 44%,29% and 33%(P=0.114,0.223,0.289), and the progression-free survival (PFS) rates were 71% and 62%,39% and 38%,24% and 29%(P=0.211,0.689,0.331), respectively. The incidence rate of chemoradiothery-and surgery-related adverse events did not differ between two groups (P=0.089-0.872).The average length of hospital stay, radiotherapy cost and preoperative treatment costs in group A were significantly less compared with those in group B (P=0.000,0.000,0.000). Conclusions Both preoperative hypofractionated and conventionally-fractionated chemoradiotherapy can be used as the regimen of preoperative chemoradiotherapy in patients with resectable thoracic esophageal carcinoma. Compared with conventionally-fractionated chemoradiotherapy, preoperative hypofractionated chemoradiotherapy has shorter treatment cycle, shorter length of hospital stay and lower radiotherapy cost, which is more easily accepted by patients.