放疗同步应用洛铂治疗中晚期食管癌的临床观察

目的对比分析含洛铂的同步放化疗方案和含顺铂放化疗方案治疗中晚期食管癌的近期疗效、生存期及毒性反应。方法选择盐城市第一人民医院2006年10月至2008年12月收治的病理证实为鳞癌的中晚期食管癌患者78例,上述患者依据随机数字表法分为两组:试验组(40例)采用洛铂+5-氟尿嘧啶(5-FU)+放疗,对照组(38例)采用顺铂+5-FU+放疗。全部患者采用6MV-X线常规分割放射治疗,总剂量为60⁶6 Gy,每次2 Gy,每周5次。化疗4周为1个周期,两组均行2个周期。按世界卫生组织评价标准评定疗效和毒性反应。结果试验组总有效率为87.5%(35/40),对照组总有效率为68.4%(26/38),试验组临床疗效优于对照组,差异有统计学意义(u=2.365,P<0.05);试验组1年、2年、3年生存率分别为75%、55%、35%,对照组分别为65.8%、39.5%、21.1%(χ2=4.026,P=0.045)。试验组恶心、呕吐发生率低于对照组,但血小板减少发生率高于对照组(P<0.05),但患者均能耐受。结论洛铂与5-FU化疗联合放疗是一种安全、有效地治疗中晚期食管癌的方法,可显著地提高有效率及生存率,明显减轻消化道毒性反应。但血小板减少发生率显著增加,值得临床进一步研究,最终结论需大样本的研究。

Clinical Observation of Lobaplatin Combined with Radiotherapy in Treatment of Advanced Esophageal Carcinoma

Objective To compare the efficacy, survival time and side effects of lobaplatin （LBP） ＋ 5-FU with concurrent radiotherapy and those of cisplatin （DDP） ＋ 5-FU with concurrent radiotherapy in treatment of advanced esophageal carcinoma. Methods Selected from Yancheng First People＇s Hospital duing Oct. 2006 and Dec. 2008, 78 cases of confirmed advanced esophageal carcinoma were included in the study,the patients were divided into two groups according to random-number table method ：40 patients in the trial group received radiotherapy plus LBP and 5-FU,38 patients in the control group were treated by radiotherapy plus DDP and 5-FU. All of the patients were treated with conventional fractionated radiotherapy using 6 MV X-ray with the dose of 2 Gy once a day ,5 times per week, a total dose of 60-66 Gy. Four weeks of chemotherapy was a period, both groups received two periods. Effica- cy and toxicity were evaluated according to WHO criteria. Results The overall response rate （ CR ＋ PR） in the trial group was 87.5% （35/40）, while in the control group was 68.4% （26/38） （u = 2. 365, P 〈 O. 05 ）. The 1-year,2-year,3-year survival rate in the trial group were 75% ,55% ,35% ,and 65.8% ,39.5% ,21.1% in the control group（ X2 =4. 026 ,P = 0. 045 ）. The incidence of major adverse effects in the trial group such as nausea and vomiting were lower compared to that in the control group, but the incidence of tbrombocytopenia was higher compared to that in the control group （ P 〈 O. 05 ）, but all within bearable limits. Conclusion LBP and 5-FU com- bined with radiotherapy is effective and well tolerated in treatment of advanced esophageal carcinoma, which could significantly improve the response rate and the overall survival rate, and obviously reduce side effect of gastrointestinal tract, but the incidence of thrombocytopenia was significantly improved. Further clinical study on this regimen is needed,and large sample studies are needed to reach the conclusion.