摘要
目的探讨常规剂量紫杉醇联合铂类与放疗同步治疗食管癌的疗效,以及扩大照射野对同步放化疗疗效的影响。方法89例局部晚期食管癌初治患者,采用根治性同步放化疗,扩大野组51例,常规野组38例。放疗总剂量60 Gy(分两阶段进行),放疗的第1周和第4周给予常规剂量的紫杉醇和铂类化疗。结果87.6%的患者完成了治疗计划,扩大野组和常规野组的治疗有效率分别为75.5%和66.7%(P=0.37)。两组的Ⅲ级以上急性毒副反应主要为白细胞、血小板下降和放射性食管炎,主要远期放射损伤为肺纤维化,两组间各种毒副反应发生率差异均无统计学意义。患者总的3年生存率为32.8%,3年无复发转移生存率为34.5%,3年局部控制率为44.0%;扩大野组和常规野组的3年生存率、3年无复发转移生存率、3年局部控制率之间差异均无统计学意义。完成治疗计划的Ⅱ、Ⅲ期患者中,扩大野组3年生存率、3年无复发转移生存率及3年局部控制率较常规野组显著提高。结论常规剂量紫杉醇联合铂类化疗同步扩大野放疗对食管癌患者是安全的,可增加Ⅱ、Ⅲ期食管癌患者的局部控制率,提高3年生存率。
Objective To assess the efficacy of concurrent chemoradiation with paclitaxel and platinum and external irradiation, and to compare the effect of extensive regional field irradiation with conventional local field irradiation for locally advanced esophageal cancer. Methods From Oct. 2000 to Jan. 2006, 89 patients with locally advanced esophageal cancer were registered in this study. All patients were inoperable or refused to undergo operation. Patients were divided into two groups： extensive regional field group（51 patients） and conventional field group（38 patients）. Patients received radiotherapy at a total dose of 60 Gy in 30 fractions within 7 weeks ,and concurrent paclitaxel 125 mg/m^2 on D1 ,cisplatin 20 mg/m^2 on D1-D3, or oxaliplatin 130 mg/m^2 on D2 in the fist and fourth week of external radiation. Results Of these patients, 87.6% completed the treament regimen with a response rate of 75.5% and 66.7% in the extensive regional field group and conventional field group, respectively. Grade 3 or severe toxicities of leucopenia （33.3% vs. 23.7% ） , thrombocytopenia （76.0% vs. 2.6% ） , and esophagitis（ 17.7% vs. 26.3% ） were observed in extensive regional field group and conventional field group, respectively. Major late toxic effect was lung fibrosis. There were no statistically significant differences in the incidence of the toxicity profile between two groups. The overall 3-year survival rates was 32.8% , and the overall 3-year recurrence and metastasis-free survival rates was 34.5%. The overall 3-year locoregional control rate was 44.0%. No significant difference was found between two groups in the 3-year survival （38.2% % vs. 28.1% , P = 0.59）. For the patients with stage Ⅱ and stage Ⅲ cancers who completed the planned treatment, large regional field radiotherapy significantly improved the 3-year survival （57.3% vs. 22.2%, P =0.03 ） or 3-year recurrent and metastasis-free survival （55.5% vs. 23.0% , P = 0.03 ） or 3-year locoregional control （65.9% vs. 30.2% , P = 0.02） than conventional field radiotherapy. Conclusion Compared with historical results, the combination of paclitaxel/platinum and radiation in this study can improve the survival for locally advanced esophageal, and the side effect is well tolerated. Compared with the conventional field group, concurrent chemoradiotherapy with the large regional field can significantly improve 3-year survival and locoregional control for stage Ⅱ or stage Ⅲ esophageal cancer.
出处
《中华肿瘤杂志》
CAS
CSCD
北大核心
2007年第10期773-777,共5页
Chinese Journal of Oncology
关键词
食管肿瘤
紫杉醇
铂类
同步放化疗
Esophageal neoplasms
Paclitaxel
Platinum
Chemotherapy with external irradiation
