同期放化疗与单纯放疗不能手术食管癌的病例对照研究

目的对不能手术食管癌同期放化疗、单纯放疗不同亚组进行生存分析,明确同期放化疗中获益患者分布,使治疗更具针对性。方法不能手术中晚期食管鳞癌患者共421例,以分期为首要配对因素,从单纯放疗的289例中选择132例,与同期放化疗的132例配对,比较两组患者的总生存率、毒副反应、失败原因。化疗采用PF方案。放疗采用常规分割方式,总剂量50-64 Gy。寿命表法计算总生存率,并用Wilcoxon检验组间差异。两组急性毒副反应、晚期副反应、失败模式的差异用x2检验。结果同期放化疗组和单纯放疗组的1年生存率分别为59.7%和54.1%(x2=6.34,P =0.013)。同期放化疗可显著提高KPS评分90、T3、N1、M0期亚组的1年生存率(x2=6.12、3.17、6.08、3.31,P=0.018、0.038、0.019、0.032)。同期放化疗组和单纯放疗组的3-4级骨髓抑制、放射性食管炎发生率分别为21.2%、28.0%和11.4%、7.6%(x2=4.69、18.87,P=0.026、0.001),其他急性毒副反应、晚期副反应发生率相似(P值均>0.05)。同期放化疗组、单纯放疗组的局部复发率分别为48.5%、66.7%(x2=9.81,P=0.001),远处转移率分别为16.7%、12.1%(x2=0.43,P=0.575)。结论同期放化疗可显著提高患者总生存率、KPS评分90和T3、N1、M0期亚组的生存率,降低区域失败率,但未能降低远处转移率,且3～4级骨髓抑制、急性食管炎发生率显著增加。

A case-control study on unresectable esophageal carcinoma patients with radiochemotherapy or radiotherapy

Objective To compare overall survival rates of the different subgroup patients the by a case-control study for the patients with unresectable esophageal carcinoma in our department in order to know which subgroup patients could get benefit from radiochemotherapy. Methods 421 patients ware eligible for this study according to the inclusion criteria from January 1996 to December 2003. 132 patients were given concurrent radiochemotherapy(RCT) and all 132 patients were given radiotherapy alone(RT). The regimen for chemotherapy was PF. Total dose of irradiation ranged from 50-64 Gy . The difference in the overall survival rates, side effects, and causes of failure between the two groups were compared. The difference of tox-icity and cause of failure between the two groups were tested by Chi-square test and the difference of overall survival was tested by Wilcoxon test. Results The 1-year overall survival rate in the RCT group (59.7%) and in the RT group (54. 1%) showed a significant difference (x2 =6. 34, P =0. 013). The o-verall survival rate of patients with KPS 90, T3, N1, and M0 were significantly higher in the CRT group than in the RT group (x2 =6.12,3. 17,6.08,3. 31 ,P =0. 018,0. 038,0. 019,0. 032). Grade 34 toxiciies of hematopoietic suppression and esophagitis were 21.2% , 28.0% in the RCT group ; and 11.4% ,7.6% in the RT group, respectively (x2 =4.69,18.87,P =0.026,0.001). The other acute toxicities and late side effects have no significant difference between the two groups (P > 0. 05,0. 05). Nor significant difference was found in the distant metastases between the two groups (16. 7% : 12. 1% ) (x2 = 0. 43, P = 0. 575). Conclusions Compared with radiotherapy alone, concurrent radiochemotherapy could significantly improve the overall survival and local control of patients with unresectable esophageal carcinoma but fails to reduce the distant matastasis. Patients treated with radiotherapy are likely to develop grade 3-4 toxicity hema-topoietic suppression and esophagitis. Radiochemotherapy is also benefitial to the group of patients with KPS 90, T3, N1, and M0.