雷替曲塞联合奈达铂同步放疗治疗食管癌术后局部复发的临床研究

目的 探讨根治术后局部复发食管鳞状细胞癌患者应用雷替曲塞联合奈达铂化疗并同步调强放疗的疗效、安全性和预后因素.方法 选取2011年10月至2015年3月四川省肿瘤医院诊治的54例根治术后局部复发食管鳞状细胞癌患者,采用雷替曲塞联合奈达铂化疗并同步调强放疗.放疗剂量60 ～ 66 Gy/30 ～ 33次.在放疗过程中至少完成2周期化疗,雷替曲塞3mg/m2,第1天,奈达铂80 mg/m2,第1天,21 d为一周期.结果 54例患者完全缓解4例(7.4％),部分缓解38例(70.4％),客观缓解率为77.8％.1、2、3年生存率和中位总生存时间分别为62.9％、27.5％、12.2％和18.0个月.1、2年无疾病进展生存率和中位无疾病进展时间分别为33.9％、12.6％和8.0个月.单因素分析显示近期疗效(x2=3.935,P=0.047)、复发部位(x2=11.280,P=0.001)和术后病理分期(x2=5.141,P=0.023)与生存率相关.COX多因素回归分析显示近期疗效(x2=6.044,P =0.014)、复发部位(x2=7.019,P=0.013)和术后病理分期(x2=3.404,P=0.036)足独立的预后因素.≥3级白细胞减少、血红蛋白降低、血小板降低发生率分别为24.1％、3.7％、13.0％.胃肠道不良反应为1～2级恶心呕吐和急性腹泻,发生率分别为18.5％、7.4％.1～2级急性放射性食管炎、急性放射性肺炎发生率为27.8％、20.4％.结论 雷替曲塞联合奈达铂化疗并同步调强放疗治疗根治术后局部复发食管鳞状细胞癌可获得较好的临床缓解率和生存率,且不良反应轻,值得进一步随机对照临床研究.治疗后近期疗效好,单部位复发和术后病理分期早的患者预后较好.

Clinical research of raltitrexed plus nedaplatin combined with concurrent radiotherapy for loco-regional recurrence of esophageal carcinoma after surgery

Objective To evaluate the efficacy,safety and prognostic factors of raltitrexed plus nedaplatin combined with concurrent radiotherapy for loco-regional recurrence of esophageal squamous cell carcinoma after surgery.Methods Between October 2011 and March 2015,54 patients with loco-regional recurrence of esophageal carcinoma after surgery in Sichuan Cancer Hospital and Institute were treated with raltitrexed plus nedaplatin combined with concurrent radiotherapy.The patients were irradiated with a dose of 60-66 Gy in 30-33 fractions.At least 2 cycles of concurrent chemotherapy were administered during radiotherapy,with 3 mg/m2 raltitrexed and 80 mg/m2 nedaplatin on the first day,every 21 days.Results The complete response rate was 7.4％ (4/54),and the partial response rate was 70.4％ (38/54).The total response rate was 77.8％.The 1-,2-,3-year survival rates and median survival time were 62.9％,27.5％,12.2％ and 18.0 months,respectively.The 1-,2-year progression-free survival rates and median progression-free survival time were 33.9％,12.6％ and 8.0 months,respectively.In univariate analysis,the short-time curative effect (x2 =3.935,P =0.047),the site of recurrence (x2 =11.280,P =0.001),postoperative stage (x2 =5.141,P =0.023) were related to the survival rate.COX multiple factors regression analysis showed that the short time curative effect (x2 =6.044,P =0.014),the site of recurrence (x2 =7.019,P =0.013),postoperative stage (x2 =3.404,P =0.036) were independent prognostic factors for survival.The incidence rates of ≥ grade 3 leukopenia,hypochromia,thrombocytopenia were 24.1％,3.7％ and 13.0％,respectively.Gastrointestinal adverse reactions were grade 1-2 nausea and vomiting and acute diarrhea,and the incidence rates were 18.5％ and 7.4％,respectively.The incidence rates of grade 1-2 acute radiation-induced esophagitis and acute radiation-induced pneumonia were 27.8％ and 20.4％,respectively.Conclusion Raltitrexed plus nedaplatin combined with concurrent radiotherapy can enhance the response rate and prolong the survival of patients with locoregional recurrence of esophageal carcinoma after surgery,which has mild toxicity and is worthy of randomized controlled clinical study.After treatment,the recent curative effect is good,and the prognosis of patient with recurrence of single part and early postoperative pathologic staging is better.