同步放化疗联合多西他赛和顺铂巩固化疗在#br#老年食管癌中的疗效分析

目的：探讨多西他赛和顺铂(docetaxel and cisplatin，DP)同步放化疗后巩固化疗对老年食管癌的疗效。方法：79例老年食管癌患者随机分为试验组(38例)和对照组(41例)。两组均采用调强放疗，处方剂量为56.0~59.4 Gy，共28~33 次，同步化疗为多西他赛 25 mg/m2+顺铂 25 mg/m2，每7 d 1次。完成同步化疗后，试验组巩固化疗方案为：多西他赛60 mg/m2，第1，8天；顺铂75 mg/m2，第1~5天，每21 d 1个周期，共4周期。对照组仅继续观察。结果：共76例患者可评价疗效。试验组获完全缓解(complete response，CR)10例，部分缓解(partial response，PR)21例，稳定(stable disease，SD)4例，进展(progressive disease，PD)2例，有效率(objective response rate，ORR)为89.2%；对照组获CR9例，PR15例，SD8例，PD7例，ORR为61.5%。两组ORR差异有统计学意义(P=0.030)。试验组和对照组的中位无进展生存期分别为19.7和10.8个月，差异有统计学意义(P=0.04)。试验组的1，2，3年生存率分别为78.5%，57.9%和37.8%，对照组分别为61.2%，42.3%和22.7%(P=0.08)。两组毒副作用均以1~2级为主，3~4级较少见，主要毒副作用表现为血液学毒性及放射性食管炎，试验组整体毒副作用略高于对照组，两组比较差异无统计学意义(P>0.05)。结论：老年食管癌患者采用同步放化疗联合DP方案巩固化疗，可以明显提高患者的疾病缓解率，延长无进展生存期。

Concurrent chemoradiotherapy followed by docetaxel and cisplatin consolidation chemotherapy in elderly patients with esophageal carcinoma

Objective: To investigate the clinical efficacy of consolidation chemotherapy with docetaxel and cisplatin (DP) in elderly patients of esophageal cancer.Methods: Seventy-nine elderly patients of esophageal cancer were randomly divided into the treatment group (38 patients) and the control group (41 patients). Intensity modulated radiation therapy (IMRT) was applied in both groups and prescribed dose was set to 56 to 59.4 Gy in 28 to 33 fractions. The concurrent chemotherapy regime for both groups was as follow: docetaxel 25 mg/m2 plus cisplatin 25 mg/m2, per week. After concurrent chemoradiotherapy, consolidated chemotherapy was applied to the treatment group with docetaxel 60 mg/m2 and cisplatin 75 mg/m2 for 3 weeks in one cycle. There was no subsequent treatment for the control group.Results: The clinical efficacy was assessed in 76 patients. For the treatment group, 31 patients (response rate, 89.2%) obtained effective response, including 10 cases with complete response (CR) and 21 cases with partial response (PR), both of which were significantly more than that in the control group (response rate, 61.5%), with 9 cases of CR and 15 cases of PR. The median progression-free survival was 19.7 months in the treatment group, clearly longer than that in the control group (10.8 months, P=0.04). The overall survival for 1-year, 2-year and 3-year were 78.5%, 57.9% and 37.8% in the treatment group versus 61.2%, 42.3% and 22.7% in the control group (P>0.05), respectively. Grade 1 and 2 adverse effects were commonly observed in both groups, such as hematologic toxicity and radiation-induced esophagitis, but there was no significant difference between the two groups. Conclusion: For elderly patients with esophageal carcinoma, the overall response rate can be significantly improved by concurrent chemoradiotherapy with subsequently consolidated chemotherapy based on docetaxel and cisplatin.