食管癌后程加速超分割放疗同期TP方案化疗疗效观察

目的评价食管癌后程加速超分割放疗同期紫杉醇联合顺铂化疗治疗食管癌近期疗效和毒性反应。方法 31例食管鳞癌随机分成单纯后程加速超分割放疗组(放疗组)17例,后程加速超分割放疗加TP方案同期化疗组(放化疗组)14例。放疗组前2/3疗程放疗用常规分割放疗,后1/3疗程缩野加速超分割放疗,总剂量684 Gy(41分次,42～44 d完成)。放化疗组放疗方案同单纯放疗组,同期TP周方案化疗,从放疗第1 d开始,顺铂40 mg/m2,d 1;紫杉醇60 mg/m2,d 1,静脉注射,每周1次,连用4周,放疗结束后再TP方案化疗2个周期,具体为顺铂40 mg,d 1～3;紫杉醇175 mg/m2,d 1。每3周1疗程。结果全组31例患者均可以评价疗效,其中放疗组完全缓解率为11.8%,同期放化疗组完全缓解率为64.3%。主要毒性反应包括骨髓抑制,恶心呕吐及放射性食道炎,放射性肺炎等。结论后程加速超分割放疗加TP方案同期化疗食管癌比单纯后程加速超分割放疗完全缓解率明显提高,有提高远期生存率的趋势,其急性毒副反应有所增加,但经过治疗均可以接受,最终结论需后期随访结果及大样本的研究结果。

Observation on the curative effect of late course accelerated hyperfractionated radiotherapy and concurrent TP chemotherapy for esophageal carcinoma

Objective To evaluate short-term curative effect and toxic effect of late course accelerated hyperfractionated radiotherapy and concurrent paclitaxel and cisplatin chemotherapy for esophageal carcinoma.Methods Thirty-one patients with esophageal squamous cell carcinoma were chosen,of whom 17 cases were randomly divided into simple late course accelerated hyperfractionated radiotherapy group,and 14 cases to late course accelerated hyperfractionated radiotherapy and concurrent TP chemotherapy group.Former 2/3 course was treated with conventional fractionated radiotherapy,while later 1/3 course was followed by accelerated hyperfractionated radiotherapy in reduced fields with total dose of 684 Gy(41 times,completed within 42~44 days).The treatment of radiotherapy and chemotherapy group was the same as radiotherapy alone group,the weekly treatment by radiotherapy for concurrent TP.From the first day of radiotherapy,treatment was administered with cisplatin 40 mg/m2,d 1,paclitaxel 60 mg/m2,d 1,intravenous injection once a week for 4 weeks.Subsequently,treatment with TP chemotherapy for two cycles,that was cisplatin 40 mg,d 1~3,paclitaxel 60 mg/m2,d 1,and 3 consecutive weeks were as a course.Results The whole group of 31 patients could be evaluated,and the recent complete remission rate was 11.8% for radiotherapy group,while that for concurrent radiotherapy and chemotherapy group was 64.3%.Main toxicities included myelosuppression,nausea,vomiting and radiation esophagitis,and radiation pneumonia.Conclusion In comparison with simple hyperfractionation group,the combined treatment tends to promote the survival rate and the complete remission rate was significantly improved.Though the acute toxicity is increased,it can be accepted after treatment.The final conclusion rests with the results by follow-up and large sample cases.