三维适形放疗同步化疗治疗中晚期食管癌的近期疗效观察

目的：评价三维适形放疗同步化疗治疗中晚期食管癌的近期疗效及毒副反应。方法：91例食管癌患者根据入选标准随机分组,49例进入三维适形放疗同步化疗（放化组）,51例单纯三维适形放疗（单放组）.放化组采用紫杉醇（150mg/m2）＋顺铂（80mg/m2）方案联合化疗,第1天及第29天重复,共2个疗程;化疗后第2天开始三维适形放疗。放射治疗：采用直线加速器分3-4个共面野进行适形照射,2Gy/次,1次/d,5次/周;放疗靶区剂量：60-70Gy/6-7周。结果：放化组与单放组完全缓解率（CR）分别为63.2%（31/49）和52.9%（27/51）,有效率（CR＋PR）分别为93.8%（46/49）和80.4%（41/51）。放化组和单放组1年局部控制率、1年生存率分别是85.7%（42/49）、78.4%（40/51）和81.6%（40/49）%、74.5%（38/51）。放化组Ⅱ度以上毒副反应白细胞减少和放射性食管炎的发生率均大于单放组（P〈0.05）,但放化组和单放组Ⅲ度＋Ⅳ度的毒副反应无统计学意义（P值〉0.05）。结论：采用三维适形放射治疗同步化疗治疗中晚期食管癌的近期疗效和局部控制率较好,虽毒副反应增加但可以耐受。

The Short-term Effects of the Three-dimensional Conformal Radiotherapy Combined with Concurrent Chemotherapy in Advanced Esophageal Carcinoma

Objective：To study the short-term curative effects and side effects of the three-dimensional conformal radiotherapy combined with chemotherapy in advanced esophageal.Method： 91 cases were divided into two groups according to the standards at random.In the radiochemotherapy groups,49 patients received two courses of chemotherapy（taxol（150mg/m2）＋cisplantin（80mg/m2）） at the 1st day and the 29th day,and received the three-dimensional conformal radiotherapy in the following days.In the radiaotherapy groups,51 patients received radiation of three or four coplanar beamlets by linear accelerator.Target dose was 60-70Gy/6-7week,which was divided to 5 times/week and 2Gy/time.Result： Complete remission（CR） rate was 63.2%（31/49）in radiochemotherapy group,and 52.9%（27/51）in radiotherapy group respectively.In the radiochemotherapy group the effective rates（CR＋PR（partial remission））was 93.8%（46/49）and was 80.4%（41/51）in radiotherapy group respectively.The 1-year local control rate and the 1-year survival rate was 85.7%（42/49）,78.4%（40/51）in the radiochemotherapy group and 81.6%（40/49）%,74.5%（38/51） in the radiotherapy group respectively.The II degree side effects（leucopenia and radioesophagitis） in the radiochemotherapy group was more than those in radiotherapy group（P0.05）.There were no significant differences between the two groups in the III degree and IV degree side effects（P0.05）.Conclusion： There were better short-term curative effects and local control rate in patients with advanced carcinoma of esophagus who received the three-dimensional conformal radiotherapy combined with chemotherapy,although with a little more side effects which could be tolerated.