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背景与目的:食管癌有早期扩散和转移的倾向,单纯放射治疗的生存率不高,复发率甚高,即使提高放疗技术也无法提高生存率。目前对于癌症的治疗提倡综合治疗。本研究比较同步放化疗与序贯化放疗对III期未手术的食管癌的近期疗效,毒副反应和长期生存率。方法:70例Ⅲ期食管癌随机分为两组,36例列入同步放化疗组,34例列入序贯化放疗组。同步放化疗组男性30例,女性6例,平均年龄60岁(范围41~70岁),病变部位,上段18例,中段10例,下段8例,病变长度6.42±1.35 cm;序贯化放疗组男性28例,女性6例,平均年龄62岁(范围42~68岁),病变部位,上段16例,中段11例,下段7例,病变长度6.35±1.53 cm。化疗方案:5-FU 500mg/m2,静脉滴注d1-4,DPP 70mg/m2,静脉滴注d1,3周一疗程,共2疗程。同步放化疗组:在化疗第一天即进行放疗。序贯化放疗组:在2疗程化疗后,第43天起放疗。放疗方法均为:6MV X线三野等中心照射,2Gy/(次、天),5次/周,共6周,肿瘤剂量为60Gy。结果:同步放化疗组CR 11例(30.5%),PR 20例(55.5%)近期有效率(CR+PR)为86.1%,序贯化放疗组:CR 4例(11.8%),PR 18例(52.9%)近期有效率(CR+PR)为64.7%,(χ2=4.106,P=0.043和χ2=4.357,P=0.037),差异有显著意义。1、2、3年生存率两组分别为75.0%,66.7%,33.3%和67.6%,43.5%,30.0%,两组间的生存率经χ2检验,未显示有差异,但1、2、3年局控率有明显差异性分别为80.6%、62.1%,44.4%vs 70.6%,54.2%,23.1%(χ2=8.411,P=0.015)。同步放化疗组的毒副反应尤其是血白细胞和放射性食管炎均大于序贯化放疗组(χ2=8.826,P=0.004和χ2=1.348,P=0.001),但III+IV度反应无差异(P>0.05),并且患者均能接受。结论:以5-FU和DDP化疗同步放疗可提高III期食管癌的近期有效率和局控率,有增加长期生存率的趋势,毒副反应虽大于序贯化放疗组,但患者均能接受。
BACKGROUND & OBJECTIVE: Esophageal cancer has the tendency of early diffusion and metastasis. The survival rate of radiotherapy alone is not high and the recurrence rate is very high. Even radiotherapy can not improve the survival rate. The current treatment of cancer advocates comprehensive treatment. This study compared the curative effect, side effects and long-term survival rate of concurrent chemoradiation and sequential radiotherapy for stage III non-operative esophageal cancer. Methods: Seventy patients with stage Ⅲ esophageal cancer were randomly divided into two groups. 36 cases were included in the concurrent chemoradiotherapy group and 34 cases were included in the sequential radiotherapy group. There were 30 males and 6 females with a mean age of 60 years (ranging from 41 to 70 years). The lesions included 18 cases in the upper segment, 10 cases in the middle segment and 8 cases in the lower segment. The length of the lesion was 6.42 ± 1.35 cm. Sequential chemoradiation The group of 28 males and 6 females, mean age 62 years (range 42-68 years), the lesion, the upper 16 cases, the middle 11 cases, the lower 7 cases, the length of 6.35 ± 1.53 cm. Chemotherapy program: 5-FU 500mg / m2, intravenous drip d1-4, DPP 70mg / m2, intravenous drip d1,3 week course, a total of 2 courses. Simultaneous radiotherapy and chemotherapy group: on the first day of chemotherapy, radiotherapy. Sequential radiotherapy group: after 2 courses of chemotherapy, radiotherapy on the 43rd day. Radiotherapy methods were: 6MV X-ray three field centers, 2Gy / (times, days), 5 times / week, a total of 6 weeks, the tumor dose of 60Gy. Results: The response rate (CR + PR) was 86.1% in CR (30.5%) and PR (20.5%) in CR group, 4 cases (11.8%) in CR and 18 cases in PR (52.9%) was 64.7% (χ2 = 4.106, P = 0.043 and χ2 = 4.357, P = 0.037). The difference was significant. The 1, 2 and 3-year survival rates were 75.0%, 66.7%, 33.3% and 67.6%, 43.5% and 30.0%, respectively. There was no significant difference in survival rates between the two groups The 3-year local control rates were significantly different (80.6%, 62.1%, 44.4% vs 70.6%, 54.2%, 23.1%, respectively) (χ2 = 8.411, P = 0.015). The toxicity of concurrent chemoradiation group was higher than that of sequential chemoradiotherapy group (χ2 = 8.826, P = 0.004 and χ2 = 1.348, P = 0.001), especially for leukocytes and radiation esophagitis P> 0.05), and patients can accept. Conclusions: Chemotherapy with 5-FU and DDP combined with concurrent radiotherapy can improve the short-term and long-term survival of patients with stage III esophageal cancer and increase the long-term survival rate. Toxic side effects are greater than those of sequential radiotherapy, but patients can accept .