联合运用三维适形放疗与化疗治疗食管癌的临床疗效:食管癌放疗好,还是化疗好

　　[摘要] 目的 探讨联合运用三维适形放射治疗（3D-CRT）与化疗治疗食管癌的近期疗效、局部控制率、生存率以及毒副反应。 方法 选择我院收治的食管癌患者80例随机分为放化组与单放组各40例。单放组行单纯3D-CRT治疗，放化组采用3D-CRT联合化疗治疗。随访3年，观察两组的近期疗效、局部控制率、生存率以及毒副反应。 结果 放化组与单放组完全缓解率分别为65.0％和52.5％，总有效率分别为92.5％和82.5％。放化组完全缓解率、总有效率显著高于对照组，差异有统计学意义（P < 0.05）。放化组1、2、3年局控率分别为90.0％、78.0％、74.0％，单放组分别为76.0％、62.0％、50.0％。放化组1、2、3年生存率分别为80.0％、68.0％、50.0％，单放组分别为68.0％、50.0％、36.0％。放化组的局控率与生存率均显著高于单放组，差异均有统计学意义（均P < 0.05）。放化组白细胞降低和放射性食管炎（Ⅲ+Ⅳ）级的发生率均大于单放组，差异均有统计学意义（均P < 0.05）。 结论 联合运用3D-CRT与化疗治疗食管癌近期疗效和局部控制率较好，可以显著提高远期生存率，且毒副反应的增加可以耐受。
　　[关键词] 食管癌；三维适形放射治疗；化学疗法；随访
　　[中图分类号] R735.1 [文献标识码] A [文章编号] 1673-7210（2012）07（c）-0028-03
　　Evaluation on the efficiency of the treatment of esophageal carcinoma by three-dimensional conformal radiotherapy combined with chemotherapy
　　YE Yijing ZHANG Jingjing LU Xiaojun LIU Yumeng OUYANG Yuxiu
　　Department of Radiation Oncology, the People"s Hospital in Zhongshan City, Guangdong Province, Zhongshan 528403, China
　　[Abstract] Objective To evaluate the clinical results, local control rates, survival rate and toxic side effect of the treatment of esophageal carcinoma by three-dimensional conformal radiotherapy (3D-CRT) combined with chemotherapy. Methods 80 patients with esophageal carcinoma were divided randomly into the concurrent 3D-CRT-chemotherapy group and 3D-CRT group with each group 40 cases. 3D-CRT was performed only in the 3D-CRT group, while the combination of 3D-CRT and chemotherapy was performed in the concurrent 3D-CRT-chemotherapy group. The clinical results, local control rates, survival rate and toxic side effect were observed after 3 years follow-up. Results The complete response rate of both group were 65.0％and 52.5％. The total effective rate was 92.5％ and 82.5％. The complete response rate and the total effective rate of the concurrent 3D-CRT-chemotherapy group were higher than those in 3D-CRT group. The differences were statistically significant (P < 0.05). The 1, 2 and 3-year local control rate in the concurrent 3D-CRT-chemotherapy group was 90.0％, 78.0％ and 74.0％ respectively, while in 3D-CRT group, they were 76.0％, 62.0％ and 50.0％respectively. The 1, 2 and 3-year survival rate in the concurrent 3D-CRT-chemotherapy group was 80.0％, 68.0％ and 50.0％, while they were 68.0％, 50.0％ and 36.0％in 3D-CRT group．The local control rate and survival rate in the concurrent 3D-CRT-chemotherapy group were all significantly higher than those in the 3D-CRT group (all P < 0.05). The incidence of decreased WBC and (III+IV) radiation esophagitis in the concurrent 3D-CRT-chemotherapy group were all higher than those in 3D-CRT group. The differences were all statistically significant (all P < 0.05). Conclusion The combination of 3D-CRT and chemotherapy not only has good clinical results and good local control rates but also improves survival rate. In addition, the patients can tolerate the toxic side effect of this method.