精确放疗同步含顺铂方案化疗治疗局部晚期食管鳞癌的临床分析

目的 分析局部晚期食管鳞癌进行精确放疗同步顺铂或顺铂联合紫杉醇脂质体化疗的临床疗效及不良反应。方法 收集精确放疗同步含顺铂方案化疗的局部晚期食管鳞癌46例，其中单药顺铂化疗（RT+P组）26例，顺铂联合紫杉醇脂质体化疗（RT+TP组）20例。回顾性分析两种同步放化疗方法的近期疗效，1、2及3年生存率以及放射性食管炎、放射性肺炎、胃肠道反应、骨髓抑制等不良反应发生率，并与同期17例单纯放疗（RT组）病例进行比较。结果 三组患者观察期内均未出现Ⅳ~Ⅴ级不良反应。三组仅12%~15%的患者出现Ⅰ~Ⅱ级放射性肺炎，发生率低、程度轻，三组相互间差异无统计学意义（P=0.939）。RT组的Ⅰ~Ⅱ级胃肠道反应发生率及Ⅲ级骨髓抑制发生率均明显低于其他组。同步放化疗组的治疗有效率高于单纯放疗组，但差异无统计学意义（P=0.161）。同步放化疗组总的1、2、3年生存率及中位生存期均高于单纯放疗组。RT+TP组的生存率明显优于RT组（P=0.019）。结论 精确放疗同步顺铂联合紫杉醇脂质体化疗治疗局部晚期食管鳞癌，具有较好的近期疗效及生存获益，明显优于单纯放疗。

Clinical Analysis of Radiotherapy Combined with Cisplatin-based Chemotherapy for Locally Advanced Esophageal Squamous Cell Carcinoma

Objective To analyze the clinical efficacy and adverse reactions of precise radiotherapy concurrent cisplatin or cisplatin combined with paclitaxel liposome chemotherapy in patients with locally advanced esophageal squamous cell carcinoma. Methods The retrospective data of 46 patients with locally advanced esophageal squamous cell carcinoma were collected. The patients were treated with precise radiotherapy concurrent with cisplatin-based chemotherapy. Twenty-six cases were delivered single agent cisplatin chemotherapy (RT+P group), 20 cases cisplatin combined with paclitaxel liposome chemotherapy (RT+TP group). The 1, 2, 3-year survival rates and the incidences of irradiation-induced esophagitis, pneumonia, gastrointestinal tract reaction and myelosuppression were assessed. The results were compared with those of 17 cases treated with radiotherapy alone (RT group). Results No grade Ⅳ-Ⅴ adverse reaction was observed in all the three groups. Only about 12%-15% patients in the three groups presented radiation pneumonia with low incidence and slight severity. There were no significant differences between the three groups (P=0.939). Mild adverse reaction of RT group was observed, of which grade Ⅰ-Ⅱ gastrointestinal tract reaction and grade Ⅲ myelosuppression were significantly lower than those in other groups. The response rates of RT+P and RT+TP groups were higher than that of RT group, however the difference was not significant (P=0.161). The 1, 2, 3-year survival rates and median survival times of RT+P and RT+TP groups were higher than those of RT group. The survival rate of RT+TP group was significantly better than that of RT group (P=0.019). Conclusion The better treatment effect and survival benefit could be obtained by precise radiotherapy concurrent with cisplatin combined with paclitaxel liposome chemotherapy for locally advanced esophageal squamous cell carcinoma, which was superior to radiotherapy alone remarkably.