三维适形放疗同步化疗治疗中晚期食管癌的疗效观察

目的：评价三维适形放射治疗（3DCRT）同步化疗治疗中晚期食管癌的近期疗效、毒副反应和长期生存率。方法：90例食管癌患者根据入选标准随机分组，46例进入3DCRT＋化疗组（放化组），44例单纯3DCRT（单放组）。化疗采用DF方案：氟尿嘧啶（5-FU）500mg/m^2＋顺铂（DDP）20mg/m^2，第1～5天静脉滴注。21天为1个周期，共化疗4～6个周期。放化组中3DCRT从化疗第1天开始，DT60—65Gy，分30～33次进行，6．0～6．5周完成，行第2周期化疗时放疗不问断。结果：放化组与单放组完全缓解率分别为65.2％和55．8％，有效率（CR＋PR）分别为93．47％和77．27％。1、2、3年局部控制率放化组分别为88．9％、78．8％、74．8％，单放组分别为78．9％、60．8％、50．0％。1、2、3年生存率放化组分别为79．8％、68．7％、50．1％，单放组分别为69．2％、50．3％、38．0％。放化组毒副反应尤其是外周血白细胞下降和放射性食管炎均大于对照组（P〈0．05），但在Ⅲ＋Ⅳ度反应方面两组无显著差异（P〉0．05），且患者均能耐受。结论：采用DF方案化疗加3DCRT治疗食管癌近期疗效和局部控制率较好，且可以提高远期生存率，虽毒副反应增加但可以耐受。

To evaluate the effect of three dimensional conformal radiotherapy (3DCRT) and chemotherapy for esophageal carcinoma

Objective:To evaluate the clinical efficacy and toxicities of concurrent three dimensional conformal radiotherapy(3DCRT) chemotherapy for esophageal carcinoma.Methods:Ninety patients with esophageal cancer were divided randomly into two groups,46 patients in the concurrent 3DCRT-chemotherapy group,while 44 patients in the only 3DCRT group.For both groups,the same 3DCRT technic was carried out by conventional fractionation,to a total dose of 60-65Gy/30-33f,during 6.0-6.5 weeks.Results:The response rate and complete response in the concurrent 3DCRT-chemotherapy group were significantly higher than those in only 3DCRT group(P<0.05).The 1-,2-and 3-year local control rate in the concurrent 3DCRT-chemotherapy was 88.9%,78.8% and 74.8%,while in only 3DCRT group,it was 78.9%,60.8% and 50% respectively;The 1-,2-and 3-year survive rate in concurrent 3DCRT-chemotherapy group was79.8%,68.7% and 50.1%,while it was 69.2%,50.3% and 38.0% in contral group.The acute toxic effect was severer in concurrent 3DCRT-chemotherapy group than in only 3DCRT group.Conclusion:Concurrent 3DCRT-chemotherapy,being able to improve the complete response rate and the survival rate of esophageal cancer,but it can also increase the acute toxic effect.