摘要
目的比较老年食管鳞癌患者(年龄≥65岁)单纯放疗(RT)和同步放化疗(CCRT)的有效性和安全性。方法收集2010年1月至2016年12月于本院首程接受根治性放疗的122例老年食管鳞癌患者,根据治疗情况分为RT组81例和CCRT组41例(替吉奥单药23例、奈达铂单药2例、雷替曲塞联合奈达铂7例和多西他赛联合奈达铂5例),采用实体瘤疗效评价标准RECIST 1.1版评价近期疗效,药物毒性反应标准NCI-CTC 4.0版评价药物毒副反应,急性放射反应评分标准(RTOG/EORTC)评价放疗毒副反应,根据随访数据进行预后分析并采用Cox比例风险回归模型进行多因素分析。结果RT组的总有效率和疾病控制率分别为84.0%和98.8%,与CCRT组92.7%和100.0%的差异无统计学意义(P>0.05)。RT组的中位无进展生存期(PFS)和总生存期(OS)分别为16.1个月和23.8个月,与CCRT组19.7个月和27.1个月的差异无统计学意义(P>0.05)。单因素分析显示影响PFS的因素包括ECOG评分、T分期和放疗剂量,影响OS的因素包括ECOG评分、T分期、N分期、临床分期和放疗剂量,多因素分析显示ECOG评分和放疗剂量是影响PFS的独立预后因素,而ECOG评分和N分期是影响OS的独立预后因素。最常见急性不良反应为放射性食管炎和骨髓抑制(多为1~2级),RT组未发生3~4级不良反应,CCRT组3~4级急性放射性食管炎、放射性肺炎和骨髓抑制的发生率升高至7.3%(3/41)、9.6%(4/41)和7.3%(3/41),差异均有统计学意义(P<0.05)。结论老年食管鳞癌行根治性放疗,放疗剂量提高至60~65 Gy,患者耐受性良好,可延长生存并提高生活质量。是否同步放化疗应综合评估后慎重选择。
Objective To compare the efficacy and safety between radiotherapy alone and radiotherapy with concurrent chemotherapy in elderly patients(age≥65)with esophageal squamous cell carcinoma.Methods From January 2010 to December 2016,122 patients who received the first course of radical radiotherapy in our hospital were assigned into RT group(81 cases)and CCRT group(41 cases,including 23 cases of tegeor alone,2 cases of nedaplatin alone,7 cases of raltitrexed combined with nedaplatin and 5 cases of docetaxel combined with nedaplatin).RECIST 1.1 was used to evaluate the short-term efficacy.NCI-CTC 4.0 was used to evaluate the side effects of drugs,and RTOG/EORTC was used to evaluate the side effects of radiotherapy.According to the follow-up data,the prognosis was analyzed and the Cox risk ratio model was used for multivariate analysis.Results The responsive rate and disease control rate of RT group were 84.0%and 98.8%,similar with 92.7%and 100.0%of CCRT group(P>0.05).The median progression free survival(PFS)and overall survival(OS)of RT group were 16.1 and 23.8 months,similar with 19.7 and 27.1 months of CCRT group(P>0.05).Univariate analysis indicated that ECOG,T stage,N stage,clinical stage and radiotherapy dose were prognostic factors for OS.ECOG,T stage and radiotherapy dose were prognostic factors for PFS.Multivariate analyses showed that ECOG and N stage were independent prognostic factors for OS.ECOG and radiotherapy dose were independent prognostic factors for PFS.The most common acute adverse reactions were radiation esophagitis and myelosuppression(mostly grade 1-2).There were no grade 3-4 adverse reactions in RT group.The incidence of grade 3-4 acute radiation esophagitis,radiation pneumonitis and myelosuppression in CCRT group increased to 7.3%(3/41),9.6%(4/41)and 7.3%(3/41).The difference was statistically significant(P<0.05).Conclusion For elderly patients with esophageal squamous cell cancer,radical radiotherapy administered at a dosage of 60-65 Gy was well tolerated and could prolong the survival and improve the quality of life.Whether to carry out concurrent radiotherapy and chemotherapy should be carefully selected after comprehensive evaluation.
作者
周彬
傅辰春
孙新臣
孙向东
ZHOU Bin;FU Chenchun;SUN Xinchen;SUN Xiangdong(Department of Radiotherapy,Qinhuai Medical District,Eastern Theater General Hospital of PLA,Nanjing 210002,China)
出处
《临床肿瘤学杂志》
CAS
北大核心
2020年第2期161-166,共6页
Chinese Clinical Oncology
关键词
食管鳞癌
放疗
化疗
老年
Esophageal squamous cell cancer
Radiotherapy
Chemotherapy
Elderly
