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目的 :评价内外照射结合加卡铂化疗综合治疗中晚期食管癌的远期疗效和并发症。方法 :1993年8月至1994年5月 ,对129例中晚期食管癌行前瞻性随机分组研究。全部病例经病理证实。随访均满4年 ,随访率98.5 %。A组33例单纯常规外照射肿瘤总量60Gy/30次/6周。B组32例先常规外照射肿瘤量达38Gy/19次时 ,开始腔内照射 ,结束时外照总量50Gy/5.5周 ,腔内总量15～16Gy/3次/3周。C组31例放疗同B组 ,仅在第1周和第6周静点卡铂100mg/次/日 ,连续5天为一疗程 ,前后2个疗程。D组33例放疗同A组 ,化疗同C组。结果 :3年生存率D组39.4 %与A组15.2 %比较有统计学差异P=0.027 ,4年生存率 ,D组为30.3 %(10/33)亦明显高于A组12.1 %(4/33) ,P=0.071 ;并发现3年无病生存率 ,D组为36.4 %(12/33)明显高于A组15.2 %(5/33) ,P=0.048 ;A、B、C、D四组的中位生存期分别为12个月、18个月、13个月、16个月。放疗后并发症包括良性食管狭窄、溃疡和瘘 ,溃疡和瘘的发生率在四组间无差别 ;A、B、C、D四组良性狭窄发生率分别为9.1 %(3/33)、43.8 %(14/32)、38.7 %(12/31)、12.1 %(4/33) ,A、D组与B、C组比较均有统计学差别 ,P<0.05。全组已死亡108例 ,局部失败致死63例 ,占58.3 % ,死于局部复发者 ,A组为55.2 %(16/29) ,明显高于B组22.2 %(6/27)
OBJECTIVE: To evaluate the long-term efficacy and complications of combined internal and external radiation with carboplatin in the treatment of advanced esophageal cancer. Methods: From August 1993 to May 1994, 129 patients with advanced esophageal cancer underwent a prospective randomized study. All cases confirmed by pathology. All patients were followed up for 4 years with a follow-up rate of 98.5%. A group of 33 cases of simple routine total radiation tumor 60Gy / 30 times / 6 weeks. In group B, 32 cases of conventional external tumor reached 38Gy / 19 times, and began to receive intracavitary irradiation. At the end of the experiment, the total amount of external irradiation was 50Gy / 5.5 weeks, and the total intraluminal volume was 15-16Gy / 3 times / 3 weeks. C group 31 cases of radiotherapy with the B group, only in the first week and the sixth week of intravenous carboplatin 100mg / time / day for 5 days for a course of treatment, before and after 2 courses. D group 33 cases of radiotherapy with A group, chemotherapy with C group. Results: The 3-year survival rate of 39.4% in group D was significantly higher than that in group A (15.2%, P = 0.027). The 4-year survival rate was also significantly higher in group D compared with 12.3% (10/33) in group D 33), P = 0.071. The 3-year disease-free survival rate was found in group D (36.4%, 12/33), which was significantly higher than that in group A (15.2%, 5/33) The median survival for the four groups was 12 months, 18 months, 13 months, and 16 months, respectively. The incidence of benign esophageal stenosis, ulcer and fistula, ulcer and fistula after radiotherapy had no difference among the four groups. The incidence of benign stenosis in group A, B, C and D was 9.1% (3/33) and 43.8 (14/32), 38.7% (12/31) and 12.1% (4/33) respectively. There was a significant difference between group A and group D and group B and C (P <0.05). 108 cases died of local failure, 58.3% died of local recurrence, 55.2% (16/29) in group A, significantly higher than 22.2% (6/27) in group B