摘要
目的探讨Ⅲ、Ⅳ期食管癌姑息性放化疗疗效及预后影响因素。方法选取2009年3月至2012年12月开县人民医院诊治的256例Ⅲ、Ⅳ期食管癌患者为研究对象,根据随机数字表法分为观察组和对照组,各128例。对照组采用单纯三维适行放疗,放射剂量3000 cGy/15 f,共15 d,第4周放射剂量1100 cGy/10 f,共5 d,第5周放射剂量1200 cGy/10 f,共5 d,第6周放射剂量1300 cGy/10 f,共5 d。观察组采用紫杉醇+奈达铂化疗1周期后,给予食管癌三维适行放疗,后程加速超分割,常规放射剂量同对照组,周期为12个月。比较两组患者的治疗效果及不良反应情况,并对影响治疗效果的因素进行分析。结果治疗12个月后,观察组近期疗效优于对照组,差异有统计学意义(P<0.05)。观察组骨髓抑制、≥2级放射性食管炎及≥2级放射性肺炎的发生率均显著高于对照组(P<0.05)。应用Kaplan-Mierer法计算,观察组患者1、3、5年生存率均显著高于对照组,差异有统计学意义(P<0.05)。治疗后,两组食管造影病灶长度、肿瘤区体积均显著缩小,纵隔淋巴结数量明显减少,与治疗前比较差异有统计学意义(P<0.05),且观察组低于对照组(P<0.05)。经Cox回归分析,Ⅲ、Ⅳ期食管癌患者预后影响因素包括食管癌病变部位、食管造影病灶长度、T分期、肿瘤区体积及同期化疗。结论Ⅲ、Ⅳ期食管癌姑息性放化疗患者近期及远期生存率高,但不良反应较多,食管癌病变部位、食管造影病灶长度、T分期、肿瘤区体积及同期化疗是影响患者预后的重要因素。
Objective To discuss palliative chemotherapy and radiation therapy and prognostic factors of stage Ⅲ,Ⅳ esophageal carcinoma. Methods Total of 256 stage Ⅲ and Ⅳ esophageal cancer patients admitted to Kaixian People’s Hospital from Mar. 2009 to Dec. 2012 were divided into observation group and control group according to the random number table method. The control group was treated with three-dimensional conformal radiotherapy,conventional radiation dose 3000 cGy /15 f for 15 d,1100 cGy /10 f × 5 d for the fourth week,1200 cGy /10 f × 5 d for the fifth week,1300 cGy /10 f × 5 d for the sixth week. The observation group was treated with paclitaxel and nedaplatin chemotherapy for 1 cycle,then three dimensional conformal radiotherapy,with accelerated hyperfractionation radiotherapy during late course,and the conventional radiation dose was same with the control group,12 months as a period. The therapeutic effect and adverse reaction were compared between the two groups,the factors influencing the treatment effect were analyzed.Results After 12 months of treatment,the curative effect of the observation group was significant better than the control group,there were statistically difference（ P 〉 0. 05）. Bone marrow suppression,≥grade 2 esophagitis and ≥grade 2 radiation pneumonitis of the observation group were significantly higher than the control group（ P 〈 0. 05）. Kaplan-Mierer method calculation indicated the 1,3,5 year survival rates in the observation group were significantly higher than those in the control group,the difference was statistically significant（ P 〈0. 05）. After treatment,the contrast lesion length,the volume of GTV of the two groups were significantly reduced,the number of mediastinal lymph nodes was significantly reduced,compared with before treatment,the difference was statistically significant（ P 〈 0. 05）,and the observation group improved more obviously（ P 〈 0. 05）. By Cox regression analysis,the independent prognosis factors for stage Ⅲ and Ⅳ esophageal cancer patients included esophageal lesions,lesion length,T staging,GTV volume and corresponding chemotherapy. Conclusion Palliative chemotherapy for stage Ⅲ and Ⅳ esophageal cancer patients has high short and long-term survival rate,but also more adverse reactions,and esophageal cancer lesions,lesion length and T staging,the volume of GTV and chemotherapy are important factors influencing the prognosis.
出处
《医学综述》
2016年第7期1427-1429,1435,共4页
Medical Recapitulate
关键词
食管肿瘤
影像学
化疗
放疗
Esophageal carcinoma
Imaging
Chemotherapy
Radiotherapy
