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[目的]观察化放疗与介入化疗及免疫栓塞治疗局部晚期胃食管结合部位腺癌的疗效及安全性。[方法]选用43例经活检证实不可手术根治性切除的局部晚期食管胃结合部位肿瘤患者随机分为介入化疗免疫栓塞组(A组20例)和放化疗组(B组23例)。介入化疗免疫栓塞法为经右股动脉插管至胃左动脉灌注[(奥沙利铂(OXA):100mg,表阿霉素(EPI):40mg,5-氟尿嘧啶(5-FU):1.0g,沙培林20k]并用适量明胶海绵栓塞;放化疗组采用三野适形放疗(DT:4500CGY/180CGY/25F)配合FOLFOX4方案同步化疗。[结果]1A组PR16例(80%),SD 4例(20%);B组PR 11例(47%),SD12例(53%),A组近期疗效明显优于B组(P<0.05);经过治疗争取手术根治切除的患者分别是10例和9例,差异无统计学意义;22组的Ⅲ~Ⅳ度不良反应发生率差异无统计学意义(P>0.05);32组平均无疾病进展生存时间分别为:19.851月(95%CI:18.245-21.454月)和16.884月(95%CI:15.474-18.294月);中位无疾病进展时间分别是21月(95%CI:17.393-24.607月)和17月(95%CI:16.038-17.962月)(P<0.05),差异有统计学意义。[结论]对于不可手术切除的局部晚期食管胃结合部位腺癌的治疗,2组毒性反应相当,无论是近期疗效还是无疾病进展生存时间,介入化疗免疫栓塞治疗组明显优于放化疗组。
[Objective] To observe the efficacy and safety of chemoradiotherapy, interventional chemotherapy and immunoembolization in the treatment of locally advanced gastroesophageal junction adenocarcinoma. [Method] Forty-three patients with locally advanced esophageal-gastric cancer who had undergone radical resection by biopsy were randomly divided into interventional chemotherapy and immunoembolization group (20 cases) and radiotherapy and chemotherapy group (23 cases). Interventional chemotherapy with immunoembolization was performed by right femoral artery cannulation to the left gastric artery for perfusion [(oxaliplatin (OXA): 100 mg, epirubicin (EPI): 40 mg, 5-fluorouracil , Shaplein 20k] and embolized with appropriate amount of gelatin sponge. The radiotherapy and chemotherapy group was treated with Sanye Conformal Radiotherapy (DT: 4500CGY / 180CGY / 25F) in combination with FOLFOX4 regimen. [Results] (20%). Group B had 11 cases (47%) of PR and 12 cases (53%) of SD, the short-term curative effect of group A was better than that of group B. The patients who underwent radical resection were 10 There was no significant difference in the incidence of grade Ⅲ-Ⅳ adverse reactions between the two groups (P> 0.05). The average progression-free survival time of the 32 groups was 19.851 months (95% CI: 18.245 - 21.454 months) and 16.84 months (95% CI: 15.474 - 18.294 months). The median progression-free time was 21 months (95% CI: 17.339-24.27 months) and 17 months (95% CI: 16.338-17.92 months) ) (P <0.05), the difference was statistically significant.Conclusion: For the treatment of locally advanced esophageal-gastric cancer with unresectable resection, the toxicity of the two groups is comparable, no matter in short-term efficacy or progression-free survival, Chemoembolization Group than the chemotherapy group.