紫杉醇联合奈达铂与5-氟尿嘧啶联合顺铂同期放疗中晚期食管癌的临床观察

目的探讨紫杉醇联合奈达铂和5-氟尿嘧啶联合顺铂治疗晚期食管癌的近期疗效及不良反应。方法回顾性分析87例经胃镜、病理检查确诊的局部晚期食管癌,随机分为紫杉醇联合奈达铂组（TN组）与5-氟尿嘧啶联合顺铂（FP组）,2组均予三维适形放疗,总剂量5600～7000 cGy,中位剂量6400 cGy,200 cGy/天,1次/天,5次/周。同步化疗TN组46例,紫杉醇60 mg/m2,静脉滴入,第1,8天;奈达铂25 mg/m2,静脉滴入,第1～3天。FP组41例,顺铂25 mg/m2,静脉滴入第1～3天,5-氟尿嘧啶500 mg/m2,静脉滴入第1～5天。2组均21天为1个周期。放疗同期化疗2个周期。结果 TN组和FP组有效率分别为91.3%和75.6%,差异有统计学意义（P〈0.05）。1年生存率TN组和FP分别为78.3%和68.3%,差异无统计学意义（P〉0.05）。不良反应方面：主要不良反应,如恶心、呕吐发生率TN明显低于FP组（P〈0.05）,血小板下降TN组高于FP组（P〈0.05）,中性粒细胞下降、放射性食管炎,2组无显著性差异（P〉0.05）。结论适形放疗同步化疗治疗食管癌,紫杉醇联合奈达铂方案较5-氟尿嘧啶联合顺铂方案可明显提高有效率,但生存率提高无显著性。不良反应更易于耐受。

Clinical Observation of Paclitaxel plus Nedaplatin and 5-Fu plus Cisplatin in Concurrent Chemoradiotherapy for Advanced Esophageal Carcinoma

Objective To evaluate the efficacy and adverse effects of paclitaxel plus nedaplatin and 5-Fu plus cisplatin in concurrent chemoradiotherapy for advanced esophageal carcinoma.Methods Retrospective study of 87 cases of locally advanced esophageal carcinoma,patients were randomized into two groups：CCRT with paclitaxel plus nedaplatin（TN group） and CCRT with 5-Fu plus cisplatin（FP group）.The CCRT regimen included radiotherapy at a total dose of 5600~7000 cGy,The median dose was 6400 cGy,200 cGy/d.46 patients in the TN group received paclitaxel 60 mg/ m2（d1,8） and nedaplatin 25 mg/ m2（d1-3）,41 patients in the FP group received cisplatin 25 mg/ m2（d1-3） and 5-FU 500 mg/ m2（d1-5）.Both regimens were repeated every 3 weeks,and with 2 courses.Results The overall response rates were 91.3% and 75.6% respectively（P0.05）,There was no significant difference in 1-year survival rates between TN group and FP group（78.3% vs 68.3% respectively,P0.05）.More patients in the FP group suffered from nausea and vomiting（P0.05）,but more patients in the TN group suffered from thrombocytopenia（P0.05）.There were no significant difference in granulocytopenia and esophagitis between TN group and FP group.Conclusion Compared with 5-Fu plus cisplatin regimen,concurrent chemoradiotherapy with paclitaxel plus nedaplatinand could significantly improve the overall response rates and is well-tolerated,but there is no significant difference in survival rate.