3D-CRT联合替吉奥治疗不能根治性手术切除的中晚期贲门癌的临床疗效和毒副反应观察

目的：探讨三维适形放疗(three dimensional conformal radiotherapy，3D-CRT)联合替吉奥治疗难以根治切除的中晚期贲门癌的疗效及其安全性研究。方法：选取2011年1月至2014年1月于我院诊治的难以手术根治的中晚期贲门癌患者64例，随机分为观察、对照两组各32例，对照组采用瘤区3D-CRT放射治疗而观察组在对照组基础上加用口服替吉奥胶囊治疗，观察两组治疗后病情缓解情况、2年生存率及放化疗不良反应发生情况，记录比较两组治疗前后KPS评分、T细胞亚群各项指标及肿瘤标志物水平。结果：治疗后观察组KPS评分、CD3+，CD4+及CD4+/CD8+、PGⅠ、PGⅡ水平较治疗前有显著提高而CEA、CA19-9水平则有显著降低，对照组KPS评分、CD8+、PGⅠ、PGⅡ水平相对于治疗前有明显增高，但CD3+，CD4+及CD4+/CD8+，CEA、CA19-9水平则有显著降低，而观察组无论是在KPS评分、T细胞亚群4项指标还是肿瘤标志物4项指标上，均与对照组有显著差异；毒副作用方面，观察组各项副反应发生率与对照组均未见显著差异；而在病情缓解情况上，观察组客观缓解率78.1%，远高于对照组53.1%(P<0.05)；而治疗后2年存活率两组差异不明显。结论：3D-CRT联合替吉奥在治疗手术难以根治的中晚期贲门癌上，能够缓解病情，疗效显著，同时还能提高患者的免疫能力，安全性较高，在符合同步放化疗适应症的情况下是一种值得推广的治疗手段。

Safety and efficacy of S-1 combined with three-dimensional conformal radiotherapy in treating advanced Cardia carcinoma

Objective: To observe the safety and effcacy of S-1 combined with three-dimensional conformal radiotherapy (3D-CRT) in treating advanced Cardia carcinoma.Methods:the treated 64 cases of advanced cardia carcinoma patients were chosen, randomly divided into 2 groups, each of 32 cases. Grouping measures: control group given 3D-CRT and observation group received treatment as the control group, but joint S-1. Compared the changes in level of T cell subset and tumor markers, KPS scores before and atfer the treatment. hTen made a comparison of the rate of remission and adverse reaction, rate of survival atfer the treat 2 years later between the 2 groups.Results:Atfer the treatment, the observation group owned a higher KPS scores, level of the CD3+, CD4+, CD4+/CD8+, and PG than before, but the level of CEA and CA19-9 were lower; the KPS, level of CD8+, PG became higher in control group but the CD3+, CD4+, CD4+/CD8+, CEA and CA19-9 were lower than before. hTe index above got signiifcant difference. And the rate of remission rate of the control group was lower than that of the observation group. hTe 2 groups owned a similar rate on the survival atfer the treatment 2 years later.Conclusion:hTe safety and effcacy of S-1 combined with 3D-CRT in treating advanced cardia carcinoma was clear, worth promoting.