调强适形放疗同期TP方案化疗治疗食管上段癌的临床研究

目的 探讨调强适形放疗（IMRT）同期TP方案（多西他赛＋顺铂）化疗治疗食管上段癌的疗效、局部控制率、生存率及不良反应.方法 78例食管上段癌患者以双盲法随机分为IMRT联合同期化疗组（放化组）和单纯IMRT组（放疗组）,每组39例.放化组采用IMRT,总剂量6 400 cGy/32次,5次/周,同期应用TP方案化疗每周1次;放疗组单纯采用IMRT.观察分析各组近期疗效、局部控制率、生存率、不良反应.结果 放化组完全缓解17例,部分缓解20例,稳定2例,总有效率为94.9％（37/39）;放疗组完全缓解9例,部分缓解19例,稳定11例,总有效率为71.8％（28/39）.放化组总有效率高于放疗组,差异有统计学意义（P＜0.05）.放化组3年局部控制率为69.2％（27/39）,明显高于放疗组的35.9％（14/39）,差异有统计学意义（P＜0.05）.放化组3年生存率为74.4％（29/39）,明显高于放疗组的43.6％（17/39）,差异有统计学意义（P＜0.05）.结论 IMRT同期TP方案化疗较单纯IMRT提高了近期疗效、局部控制率、生存率,其近期和远期不良反应可以耐受.

A clinical research of intensity modulated radiation therapy combined with TP concurrent chemoradiotherapy for superior segment of esophageal cancer

Objective To evaluate the efficacy,local control rate,survival rate and adverse reaction of intensity modulated radiation therapy （IMRT） combind with Tp concurrent chemoradiotherapy （docetaxel and cisphtin） for superior segment of esophageal cancer.Methods Seventy-eight patients with superior segment of esophageal cancer were divided randomly into IMRT combined with TP concurrent chemoradiotherapy group （chemoradiotherapy group） and single IMRT group （radiotherapy group） by double blind method with 39 cases each.The patients in chemoradiotherapy group received chemoradiotherapy,while other patients in radiotherapy group received only radiotherapy.For both groups,the same radiation technic was given with chemoradiotherapy,the total dose was 6 400 cGy/32 f.For the patients in chemoradiotherapy group were also given with TP concurrent chemotherapy weekly.The efficacy,local control rate,survival rate and adverse reaction was observed.Results Complete remission in 17 cases,partial remission in 20 cases,stable in 2 cases,the total effective rate was 94.9％ （37/39） in chemoradiotherapy group.Complete remission in 9 cases,partial remission in 19 cases,stable in 11 cases,the total effective rate was 71.8％ （28/39） in radiotherapy group.There was significant difference in the total effective rate between two groups（P ＜ 0.05）.The 3-year local control rate was 69.2％ （27/39） in chemoradiotherapy group,which was higher than that in radiotherapy group35.9％（14/39）],and there was significant difference（P ＜ 0.05）.The 3-year survival rate was 74.4％（29/39） in chemoradiotherapy group,which was higher than that in radiotherapy group 43.6％（17/39）],and there was significant difference （P ＜0.05）.Conclusion IMRT combined with TP concurrent chemoradiotherapy can improve the efficacy,local control me,survival rate of esophageal cancer,but can also increase the acute toxic effect.