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目的探讨局部晚期非手术食管癌患者同步放化疗后的近期疗效、生存率及毒副反应。方法选择未行手术的局部晚期食管癌患者108例,将其分为同步放化疗组(n=66例)和单纯放疗组(n=42例)。采用以铂类为基础的化疗方案:顺铂25~30 mg/m2(第1~2天)+氟尿嘧啶500 mg(第1~5天)+亚叶酸钙300 mg(第1~5天)静点1个周期,或单药氟尿嘧啶500 mg放疗期间静点。放疗方案为:食管病变部位适形调强放射治疗(intensity modulated radiation therapy),总剂量为50~66 Gy。治疗结束后对两组的疗效和不良反应进行分析比较。结果同步放化疗组与单纯放疗组的治疗有效率分别为90.9%和71.4%(P=0.025),两组转移复发率分别为48.5%和52.4%(χ2=1.330,P=0.722),两组的1、2、3年生存率分别为83.9%、62.5%、46.4%和63.5%、50.1%、42%(χ2=1.697,P=0.193)。两组均无严重的3~4级放射性食管反应及Ⅳ度血液毒副反应的发生。同步放化疗组中2种化疗方案的近期疗效、转移复发率及生存率比较差异均无统计学意义(P>0.05)。单因素分析结果显示,近期疗效与有无复发转移是生存期的影响因素。多因素分析显示,治疗方式、近期疗效及有无转移复发为影响生存的因素。结论对于局部晚期食管癌患者,同步放化疗的近期疗效好于单纯放射治疗,同步放化疗和单纯放射治疗均无严重不良反应。治疗方式、近期疗效及有无复发转移是其预后影响因素。
Objective To investigate the short-term curative effect, survival rate and toxicity of patients with locally advanced non-surgical esophageal cancer after concurrent chemoradiotherapy. Methods 108 patients with locally advanced esophageal cancer who underwent surgery were divided into two groups: n = 66 and n = 42. Platinum-based chemotherapy regimens: cisplatin 25 ~ 30 mg / m2 (days 1 ~ 2 days) + fluorouracil 500 mg (days 1 ~ 5) + leucovorin 300 mg (days 1 ~ 5) Point 1 cycle, or single-agent fluorouracil 500 mg during radiotherapy static point. The radiotherapy program is: intensity modulated radiation therapy for esophageal lesions at a total dose of 50 Gy to 66 Gy. After treatment, the efficacy and adverse reactions of the two groups were analyzed and compared. Results The effective rates of concurrent radiotherapy and chemotherapy were 90.9% and 71.4% respectively (P = 0.025). The recurrence rates of the two groups were 48.5% and 52.4% (χ2 = 1.330, P = 0.722) The 1-, 2- and 3-year survival rates were 83.9%, 62.5%, 46.4% and 63.5%, 50.1% and 42%, respectively (χ2 = 1.697, P = 0.193). No serious grade 3 to 4 esophageal reaction and grade IV blood toxicity were found in both groups. There was no significant difference in the curative effect, metastasis recurrence rate and survival between the two chemotherapy regimens in concurrent chemoradiotherapy group (P> 0.05). Univariate analysis showed that the recent efficacy and recurrence and metastasis were the influencing factors of survival. Multivariate analysis showed that the treatment methods, the recent curative effect and the presence or absence of metastasis and recurrence were the factors influencing survival. Conclusions For patients with locally advanced esophageal cancer, the recent curative effect of concurrent chemoradiotherapy is better than that of radiotherapy alone. There is no serious side effects of concurrent chemoradiation and radiotherapy alone. The way of treatment, the recent curative effect and the presence or absence of recurrence and metastasis are the prognostic factors.