三维适形再程放疗同步联合奈达铂加氟尿嘧啶治疗放疗后复发食管癌临床效果观察

目的观察三维适形再程放疗同步联合奈达铂加氟尿嘧啶（5-Fu）治疗放疗后局部复发食管癌患者的疗效及副反应。方法54例放疗后局部复发的食管癌患者，随机分成两组：研究组27例，行三维适形再程放疗（50～56Gy／25～28F）同步联合奈达铂80mg／（m^2·d），静脉滴注，第1天加5-FU350mg／（m^2·d），第1—5天化疗；于放疗中及放疗后配合奈达铂加5一Fu化疗。对照组27例，行三维适形再程放疗（50—56Gy／25～28F）序贯联合奈达铂80mg／（m^2·d），静脉滴注，第1天加5-FU350mr／（m^2·d）d1。5）化疗；于放疗后使用奈达铂加5-FU化疗。两组患者化疗均3～4周为1个周期，共2—4个周期。结果（1）两组近期疗效：研究组与对照组的近期疗效（CR＋PR）分别为59．2％（16／27）和55．5％（15／27），两组比较差异无统计学意义（x^2=0．076，P=0．5）。（2）生存率：研究组与对照组的1、2、3年生存率分别为54．2％、26．4％、15．7％和40．3％、19．7％、10．8％，两组比较差异有统计学意义（x^2=6．87，P=0．032）。（3）毒副反应：研究组血液系统毒副反应高于对照组，差异有统计学意义（x^2=5．882，P=0．043）；两组非血液系统毒副反应差异无统计学意义（x^2=4．25，P=0．75）。（4）放射性食管炎：两组差异无统计学意义（x^2=0．869，P=0．661）。结论三维适形再程放疗同步联合奈达铂与5-Fu化疗对放疗后复发食管癌有较好疗效，可提高生存率。

Clinical observation of conformal re-irradiation combined with nedaplation plus 5- fluorouracil synchronously in treatment of recurrent esophageal carcinoma

Objective To evaluate the therapeutic effect and side effects of three-dimensional conformal re-irradiation combined with nedaplation plus 5-fluorouracil synchronously in treatment of recurrent esophageal carcinoma. Methods Fifty-four patients with reeurrentesophageal carcinoma were randomly divided into two groups ： study group with 27 patients who were treated with three-dimensional eonformal re-irradiation （ 50 - 56 Gy/25 -28 F） combined with chemotherapy synchronously and control group with 27 patients who were treated with re-irradiation （50 - 56 Gy/25 - 28 F）combined with chemotherapy orderly. The patients of study group were treated with nedaplation80 rag/（ m2 · d）plusS-FU 350 mg/（ m2 · d）, from 1 to 5 day synchronously in radiotherapy and after radiotherapy. The patients of control group were treated with nedaplation80 mg/（ m2 · d） plus 5-FU 350 mg/（m2 · d）d from 1 to 5 day orderly after radiotherapy. The patients were treated every 3 -4 weeks as a cyele with total 2 - 4 cycles in these two groups. Results （ 1 ） The short-term effect： the short-term effeet（CR ＋ PR） of the two groups were 59. 2% （ 16/27 ） and 55. 5% （ 15/27 ） respectively, there was no statistical difference between the two groups（ X2 = 0. 076, P = O. 5 ）. （ 2 ） The survival rate ： the survival rate of one,two and three years were 54. 2% ,26. 4% ,15. 7% in study group and 40. 3% ,19. 7% ,10. 8% in control group respectively. The survival rate in study group was significantly higher than that in control group （ X2 = 6. 87 ,P = 0. 032 ）. （3）The study of side effects：there was significant difference on the hematologic toxicity between the study group and the control group （ X2 = 5. 882 ,P = 0. 043 ）. And there was no significant difference on the non-hematologic toxicity between the two groups （X2 = 4. 25, P = 0.75 ）. （4）The acute radiationesophagitis ：There was no statistical difference on radiation-esophagitis between the two groups（ X2 = 0. 869 ,P = 0. 661 ）. Conclusion Three-dimensional conformal re-irradiation combined with nedaplation plus 5-fluorouracil synchronously for recurrent esophageal carcinoma has a good efficacy and can also improve the survival rate.