多西他赛乏氧增敏放射治疗食管癌的临床研究

目的探讨周剂量多西他赛乏氧增敏放射治疗食管癌的临床疗效。方法选择100例乏氧阳性食管癌患者随机分为增敏组50例和单放组50例。两组均行前程普通放疗加后程适形放疗,总剂量DT66～70 Gy/33～35次,6.5-7周完成。增敏组在放疗同期行多西他赛化疗,每次40 mg,每周1次,总量为160～200 mg/4～5次,同时给一定的对症支持治疗。治疗前及治疗后行上消化道造影、胸部CT,腹部B超等检查,以评价疗效。结果增敏组总有效率（CR＋PR）为92%,单放组总有效率为66%,两组差异具有统计学意义（P〈0.05）;两组中位生存时间分别为31月和20月,1、2、3年生存率分别为（89.8±3.7）%（95%可信区间）、（78.1±6.4）%、（38.7±9.1）%和（85.6±3.5）%、（49.8±7.7）%、（15.8±11.5）%。两组比较,1年总生存率（OS）差异无统计学意义（P〉0.05）,2年、3年OS差异有统计学意义（P〈0.05）,两组1、2、3年局部控制率分别为78.9%、52.3%、18.6%和66.1%、32.4%、9.8%,两组比较差异有统计学意义（P〈0.05）。增敏组骨髓抑制毒副反应较单放组增加,但经处理后均能顺利完成治疗。结论周剂量多西他赛乏氧增敏放射治疗食管癌疗效较好,不良反应可以耐受。

Docetaxel used as radiosensitizer in radiotherapy for hypoxic esophageal cancer

Objective To investigate the clinical effects of docetaxel used as a hypoxic tumor cell radiosensitizer in the radiotherapy for hypoxic esophageal cancer.Methods A total of 100 patients with hypoxic esophageal carcinoma were randomly divided into radiosensitizer group（n=50） and radiotherapy along group（n=50）.The total dose of radiotherapy was 66～70 Gy/33～35 F/6.5-7 W for both groups,including 40 Gy in conventional technique and 26～30 Gy of boost dose by conformal technique.Patients in the radiosensitizer group also received weekly docetaxel of 40mg concurrent with the radiotherapy.Upper digestive tract radiography,chest CT scan and upper abdomen ultrasonography were performed before and after the treatment.Results The overall response rates（CR＋PR） were 92% and 66% in the radiosensitizer and the radiotherapy group（P〈0.05）.The median survival time was 31 months and 20 months respectively.The 1-,2-,and 3-year survival rates were（89.8±3.7）%,（78.1±6.4）% and（38.7±9.1）% vs（85.6±3.5）%,（49.8±7.7）% and（15.8±11.5）% for two groups,respectively.The difference was not significant for 1-year survival rate（P〉0.05）,but for 2-and 3-year survival rates the differences were significant（P〈0.05） between two groups.The 1-,2-,and 3-year local control rates were 78.9%,52.3% and 18.6% vs 66.1%,32.4% and 9.8% for two groups（P〈0.05）.The rate of hematological toxicity was higher in radiosensitizer group than that in the radiotherapy group,but the toxic reaction was mild and tolerable.Conclusion Docetaxel used as an hypoxic tumor cell radiosensitizer in the radiotherapy for hypoxic esophageal cancer is a feasible regimen with tolerable adverse effects.