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。

Clinical Observation on Nedaplatin Plus Concurrent Three-dimensional Conformal Radiotherapy for Advanced Esophageal Cancer

Treatment of esophageal cancer with radiotherapy was not very effective because of recurrence of cancer. Aims： To investigate the effect and side effects of nedaplatin （NDP） plus concurrent three-dimensional conformal radiotherapy for advanced esophageal cancer. Methods： Seventy five patients with advanced esophageal cancer confirmed histopathologically were randomly divided into radiotherapy group （37 cases, given conventional radiotherapy of 6 MV-X ray or 15 MV-X ray, 2.0 Gy×5 per week for 6 to 7 weeks） and NDP plus concurrent radiotherapy group （38 cases, additionally given NDP 30~40 mg once a week for 6 weeks）. The short-term effect and short-term side effects were evaluated 3 months after treatment, and long-term effect was recorded and assessed at the end of follow up. Results： The overall effective rate of NDP plus concurrent radiotherapy group was significantly higher than that of radiotherapy group （78.9% vs.51.4%, P〈0.05）. There were no significant differences in incidences of ≥grade 2 radiation esophagitis and ≥grade 3 radiation esophagitis between radiotherapy group and NDP plus concurrent radiotherapy group （40.5% vs. 50.0%, 10.8% vs. 18.4%, P〉0.05）. The 1-year and 3-year local control rates （73 % vs. 63.6%, 49.2 % vs.43.3 %, P〈0.05）, and 1-year and 3-year survival rates （69.8 % vs. 49.8%, 41.3 % vs. 30.2 %, P〈0.05） of NDP plus concurrent radiotherapy group were significantly higher than those of radiotherapy group. Conclusions： The short-term and long-term effects of NDP plus concurrent radiotherapy were significantly higher than those of radiotherapy, and patients could tolerate its short term adverse effects, therefore hopefully it has the prospect to be used clinically.