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食管癌术前放化疗疗效分析

2018-05-12 12:00:16    作者:admin    www.5alw.com

                  作者:王珏 孙成超 吴式?张萍 林超西

【摘要】  目的 探讨术前同步放化疗治疗食管癌的疗效及围手术期并发症。方法 2000年12月至2006年8月,26例食管癌初治患者,采用常规放射野治疗,肿瘤量40Gy,在放疗的第1周和第4周均给予常规剂量紫杉醇和铂类化疗2个疗程,休息4~6周后手术。结果 放化疗并发症主要为骨髓抑制,肺部损害,食管炎。放化疗组的完全病理缓解率为38.46%,急性毒副反应仅1~2级,癌肿局部控制率73.08%,远处转移率26.92%,3年生存率62.96%,5年生存率54.56%,无病生存率63.82%。多因素分析显示影响食管癌生存率的因素有病变长度、肿瘤浸润深度、淋巴结转移情况。术前放化疗对于手术难度没有增加,术后并发症主要是肺部并发症。结论 应用术前同步放化疗治疗食管癌是安全的,取得了较好的疗效。

【关键词】  食管癌 手术 放射疗法 化学疗法


  【Abstract】  Objective  To evaluate the tolerance and the short-term outcome of preoperative chemoradiotherapy for patients with locally advanced esophageal carcinoma, to observe effects of preoperative chemoradiotherapy on tumor resection rate, incidence of complications after surgery. Methods  From December 2000 to August 2002, twenty-Six consecutive patients with locally advanced esophageal carcinomas were entered into this study. Each involved radiotherapy, in a dose of 40Gy.The chemotherapy consisted of Paclitaxel and Cisplatin. The chemotherapy was administered in continuous infusion for the first week and the fourth week. After completion of chemoradiotherapy, clinical restaging was performed. Esophagectomy and lymphadenectomies were performed 4-6 weeks after chemoradiotherapy.  Results  Twenty-five patients completed the planned chemoradiotherapy. The toxicities of chemoradiotherapy such as myelotoxicity, pulmonary toxicity, esophagitis were grade I or II. The pathological complete response rate was 38.46%, the three years survival rate of combine therapy and surgery alone was 62.96%,five years survival rate was 54.56% ,the local control ratio was 73.08%, the distant metastasis rate was 26.92%.The disease free survival(DFS)rate was 63.82%.These prognosis factors were found to influence survival in a multivariate analysis: the location of the tumor, the disease stage, the length of the tumor, and the lymphoid node metastasis. Conclusions  The results of this study suggest that the strategy of chemoradiotherapy followed by surgery is safe. Preoperative chemoradiotherapy can significantly reduce the tumor stage, and achieve substantially high clinical response rate and pathological complete response rate.

  【Key words】  Esophageal carcinoma  surgery  radiotherapy  chemotherapy   

  食管癌是我国常见恶性肿瘤之一,其发病率高达33.7%~40.5%,并呈高度恶性,只有40%~60%为局限性病变,多数已有淋巴结转移或血行转移。以往对于食管癌多采用单纯手术治疗,但其远期疗效不佳,5年生存率仅为24%[1]。近年食管癌的治疗强调多种模式的联合应用,食管癌的新辅助治疗是目前的研究热点,但对于其是否有效还存在较多争论,目前联合治疗的最佳模式尚在探索中,本院2000年12月至2006年8月,采用常规剂量紫杉醇和铂类同步术前放化疗治疗食管癌26例,疗效较好,现报告如下。

  1  资料与方法

  1.1  一般资料 

  26例患者,男24例,女2例;年龄44~70岁,中位年龄56岁。Ⅱ期17例,Ⅲ期9例。胸段食管癌初治患者,卡氏评分(KPS)≥70;治疗前临床分期均按临床表现和体格检查,食管胃镜检查,胸部CT及食管吞钡X线摄片检查,无锁骨上淋巴结转移,经颅脑CT、盆腹腔B超或CT、骨ECT检查,排除重要脏器转移。临床分期均为II~III期(T2~4N0~1M0,UICC 1997年标准),治疗前经胃镜活检病理学检查证实均为鳞癌。

  1.2  治疗方法   

  术前采用6MV X射线前后对穿照射,2.0Gy/(次?d), 肿瘤量40Gy,共20次,4周完成。放疗期间同步化疗2个疗程,化疗方案是紫杉醇联合顺铂,放疗第1周给予紫杉醇125mg/m2,第1天;顺铂20mg/m2, 第1~3天;第2个疗程化疗在第4周(放疗结束前)完成,第2个疗程的化疗剂量根据毒副反应做相应调整。化疗前要求血白细胞(WBC)>3.5×109,PLT>75×109, 肝肾功能正常范围。放化疗结束后休息4~6周,行胸段食管切除和区域淋巴结清扫,食管胃胸顶或颈部吻合,常规清扫的淋巴结:气管隆突下淋巴结、食管旁淋巴结、左下肺静脉淋巴结、左下肺韧带淋巴结、左肺动脉淋巴结、贲门旁淋巴结和胃周淋巴结。
                        
  2  结果

  2.1  放化疗副作用     

  联合治疗全部患者完成第1个疗程化疗,1例未完成第2个疗程化疗,1例患者第2个疗程化疗减量。全部患者完成放疗治疗。放化疗副作用:主要为血液系统毒性,血液系统反应为34.62%(9/26),非血液系统反应为46.16%(12/26),表现为消化道反应及脱发等;放射性食管炎15.38%(4/26),无放射性肺炎发生,无Ⅲ级以上肝肾功能损害发生。Ⅲ级以上白细胞下降7.69%(2/26),Ⅲ级以上血小板下降为7.69%(2/26);非血液系统反应主要为呕吐、脱发、肌肉关节酸痛及放射性食管炎。术后病理检查报告病理缓解率为38.46%(10/26)。术后死亡1例3.8%(1/26),死于严重肺部感染呼吸衰竭。

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