洛铂或顺铂联合5-Fu同步放化疗治疗不能手术的中晚期食管癌的临床观察

目的：观察洛铂或顺铂联合5-Fu同步放化疗治疗不能手术的中晚期食管癌患者的近远期疗效和患者不良反应。方法60例中晚期食管鳞状细胞癌患者随机分成2组。实验组36例，洛铂30 mg／m2静脉滴注2 h，d1，5-Fu 500 mg／m2，静脉推注d1～d5，21 d为1周期，共4周期；对照组24例，顺铂30 mg／m2静脉滴注d1～3，5-Fu 500 mg／m2，静脉推注d1～d5，21 d为1周期，共4周期。同时2组均采用后程加速超分割三维适形放疗：首先运用常规分割照射1．8 Gy／d，5次／周，共23次，DT 41．4 Gy，接着进行加速超分割照射1．5 Gy，每日2次，9日共27 Gy，全程6～7周，照射DT 68．4 Gy。结果全部患者均完成治疗，洛铂组和顺铂组近期有效率各自为86．1％与66．7％，洛铂同步放化疗组和顺铂同步放化疗组的1年与2年生存率试验组与对照组各自为83．3％，61．1％和66．7％、41．6％。不良反应方面，洛铂组血小板下降发生率（66．7％）高于顺铂组（62．5％），但差异无统计学意义（P＞0．05）；肾毒性、神经毒性发生率比较差异无统计学意义（P＞0．05）；洛铂组未出现Ⅲ～Ⅵ度胃肠道反应（0例，0％），远远低于顺铂组（5例，20．8％），差异具备统计学意义（ P＜0．05）。结论洛铂联合5-Fu同步放化疗治疗中晚期食管癌是安全有效的，且不良反应轻微，可以将其进行临床方面的深入推广，但仍需扩大病例数深入评价。

Clinical Study of Lobaplatin/Cisplatin Combined with 5-Fu and Concurrent Radiotherapy for Inoperable Esophageal Cancer

Objective To investigate the short-term and long-term treatment effects and side reactions of lobaplatin/cis-platin plus 5-Fu and concurrent radiotherapy for inoperable middle-advanced esophageal cancer.Methods 60 patients with mid-dle-advanced esophageal squamous cell cancer were were randomly,divided into 2 groups,36 patients of group A were adminis-tered lobaplatin(30 mg/m2 ) for 2 h on day 1,and 5-Fu(500 mg/m2 ) injected intravenously from day 1 to 5 for 1 cycle,in an in-terval of 21 days for totally 4 cycles;24 patients of group B were administered cisplatin(30 mg/m2 ) d1~3,and 5-Fu(500 mg/m2 ) injected intravenously from day 1 to 5 for 1 cycle,in an interval of 21 days for totally 4 cycles.At the same time,late-course accelerated hyperfractionated three-dimensional conformal radiotherapy was performed.Patients were firstly treated with conven-tional fractionated irradiation(1.8 Gy/d,5 times/week,a total of 23 treatments,and DT 41.4 Gy) ,and then treated with acceler-ated hyperfractionated irradiation(1.5 Gy,2 times/d,a total of 27 Gy in 9 days,an entire course of 6~7 weeks,and DT 68.4 Gy).Results All patients completed treatment,and the total effective rate of group A and group B were 86.1%and 66.7%,re-spectively.1-and 2-year survival rates were 83.3%,61.1%and 66.7%,41.6%,respectively.The side-effects were mainly my-leosuppression,there had no statistic differences(P>0.05),However,the side effects ofⅢ~Ⅵgastrointestinal reaction in the 2 groups were 0%and 20.8%,respectively,there had statistic difference(P<0.05).Conclusion Lobaplatin plus 5-Fu combined with concurrent radiotherapy is safe and effective for middle-advanced esophageal cancer.However,this result warrants further e-valuation by randomized clinical studies.