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目的 :探讨术前诱导化疗序贯同步放化疗治疗局部晚期食管癌的疗效与不良反应。方法 :将111例经病理证实的Ⅱ~ⅢB期食管癌(T3N0M0,T1~3N1~2M0或T4N0~1M0)随机分为术前诱导化疗后序贯同步放化疗组(诱导组)52例和术前同步放化疗组(同步组)59例。诱导化疗方案:紫杉醇135 mg/m2(第1天),顺铂25 mg/m2(第1~3天),每21 d重复,共2个周期。同步放化疗方案:紫杉醇60 mg/m2(第1、8天),顺铂20 mg/m2(第1~3天),每28 d重复,放疗期间共完成2个周期化疗。放疗剂量为45Gy。手术在完成同步放化疗后3~8周进行。结果:放化疗后诱导组有效率(完全缓解+部分缓解)高于同步组(78.8%vs.61.0%,χ2=4.135,P=0.042)。同时诱导组术后TRG0率亦高于同步组(42.6%vs.22.4%,χ2=4.435,P=0.035)。诱导组的1、2、3年总生存率和1、2、3年的无进展生存率均优于同步组。诱导组的急性不良反应发生率要高于同步组,但多为轻度的Ⅰ~Ⅱ度反应,两组的晚期不良反应相似。结论:术前诱导化疗序贯同步放化疗治疗可切除的局部晚期食管癌能够提高局部控制率和生存率,不良反应可以耐受,值得临床推广应用。
Objective : To investigate the efficacy and adverse reactions of preoperative induction chemotherapy in the treatment of locally advanced esophageal carcinoma with sequential concurrent radiotherapy and chemotherapy. Methods: 111 cases of pathologically confirmed II-IIIB esophageal cancer (T3N0M0, T1~3N1~2M0 or T4N0~1M0) were randomly divided into preoperative induction chemotherapy followed by concurrent chemotherapy and radiotherapy (induction group) 52 cases and surgery. Pre-chemotherapy and chemotherapy group (synchronous group) 59 cases. Induction chemotherapy: paclitaxel 135 mg/m2 (day 1) and cisplatin 25 mg/m2 (days 1 to 3), repeated every 21 days for a total of 2 cycles. Simultaneous radiochemotherapy: paclitaxel 60 mg/m2 (Days 1 and 8) and cisplatin 20 mg/m2 (Days 1 to 3), repeated every 28 days, and 2 cycles of chemotherapy were completed during radiotherapy. Radiotherapy dose is 45Gy. Surgery was performed 3 to 8 weeks after completion of concurrent radiotherapy and chemotherapy. RESULTS: The effective rate (complete response + partial response) of the induction group after radiotherapy and chemotherapy was higher than that of the synchronous group (78.8% vs. 61.0%, χ 2 = 4.135, P = 0.042). At the same time, the TRG0 rate in the induction group was also higher than that in the synchronous group (42.6% vs. 22.4%, χ2=4.435, P=0.035). The 1-, 2-, and 3-year overall survival rates and progression-free survival rates at 1, 2, and 3 years in the induction group were better than those in the synchronized group. The incidence of acute adverse reactions in the induction group was higher than that in the synchronous group, but mostly mild I-II reactions. The late-stage adverse reactions in the two groups were similar. Conclusion: Preoperative induction chemotherapy followed by concurrent chemoradiotherapy for locally resectable esophageal cancer can improve the local control rate and survival rate. Adverse reactions can be tolerated and worthy of clinical application.