90例不同部位食管癌同步放化疗后疗效分析

doi:10.3760/cma.j.issn.1673-422X.2016.03.004

摘要/Abstract

摘要： 目的探讨颈胸上段食管癌和胸中下段食管癌同步放化疗疗效及食管狭窄情况。方法选取2011年1月至2014年12月在江苏省苏北人民医院诊治的不同部位食管癌初治患者90例，均行同步放化疗，放疗中位剂量60 Gy，化疗方案为紫杉醇联合奈达铂方案。其中，颈胸上段食管癌48例，胸中下段食管癌42例，比较两组近期有效率、局部控制率、生存率及食管狭窄情况。结果随访率为100%，颈胸上段食管癌组和胸中下段食管癌组近期有效率分别为81.2%、73.8%（χ²=0.717，P=0.397）；1年局部控制率分别为90.3%、71.8%（χ²=5.865，P=0.015）；1年生存率分别为87.5%、69.0%（χ²=4.580，P=0.032）；中度及以上程度食管狭窄发生率分别为55.6%、29.4%（χ²=5.360，P=0.021）。两组在近期疗效方面差异无统计学意义，而颈胸上段食管癌组在1年局部控制率、1年生存率和食管狭窄发生率上均明显高于胸中下段食管癌组，差异有统计学意义。结论颈胸上段食管癌疗效较胸中下段食管癌好，但颈胸上段食管癌放疗后食管狭窄程度较胸中下段食管癌重。

关键词: 食管肿瘤, 预后, 放射疗法, 药物疗法

Abstract: Objective To explore the effectiveness and esophageal strictures of concurrent chemoradiotherapy in patients with cervical and upperthoracic esophageal cancer (EC) and middle-thoracic and lower-thoracic EC. Methods Between January 2011 and December 2014, ninety patients with different parts of EC were treated with radiotherapy combined with concurrent chemotherapy in People′s Hospital of Subei. The median irradiation dose was 60 Gy. The chemotherapy regimens consisted of Paclitaxel and Nedaplatin. Of all the patients, 48 patients had cervical and upper-thoracic EC, 42 patients had middle-thoracic and lower-thoracic EC. The response rates, the local control rates, the survival rates and esophageal strictures were evaluated between two groups. Results The follow-up rate was 100%. The response rates of the patients with cervical and upper-thoracic EC and middle-thoracic and lower-thoracic EC were 81.2% and 73.8% (χ²=0.717, P=0.397), respectively. The 1-year local control rates of the patients with cervical and upper-thoracic EC and middle-thoracic and lower-thoracic EC were 90.3% and 71.8% (χ²=5.865, P=0.015), respectively. The 1-year survival rates of the patients with cervical and upper-thoracic EC and middle-thoracic and lower-thoracic EC were 87.5% and 69.0% (χ²=4.580, P=0.032)， respectively. The moderatetosevere esophageal strictures rates of the patients with cervical and upper-thoracic EC and middlethoracic and lower-thoracic EC were 55.6% and 29.4% (χ²=5.360, P=0.021), respectively. There were no significant differences in short-term effects between the cervical and upper-thoracic EC and middle-thoracic and lower-thoracic EC. The patients with cervical and upper-thoracic EC showed significantly higher 1-year local control rates, 1-year survival rates and esophageal strictures rates than those with middle-thoracic and lower-thoracic EC. Conclusion The effectiveness of concurrent chemoradiotherapy is better in the patients with cervical and upper-thoracic EC than in those with middle-thoracic and lower-thoracic EC, but the esophageal stenosis is more severe in the patients with cervical and upper-thoracic EC than in those with middlethoracic and lower-thoracic EC.

Key words: Esophageal neoplasms, Prognosis, Radiotherapy, Drug therapy

陈丽,汪步海,戴尔珣,葛宜枝,蒋亚齐. 90例不同部位食管癌同步放化疗后疗效分析[J]. 国际肿瘤学杂志, 2016, 43(3): 177-179.

Chen Li, Wang Buhai, Dai Erxun， Ge Yizhi, Jiang Yaqi.. Concurrent chemoradiotherapy for 90 patients in different parts of esophageal carcinoma[J]. Journal of International Oncology, 2016, 43(3): 177-179.

参考文献

［1］ Aoki T, Nakamura T, Kakeji Y. Current status and future prospects of chemoradiotherapy for esophageal cancer［J］. Gan To Kagaku Ryoho, 2015, 42(10): 1148-1151. ［2］ Tu L, Sun L, Xu Y, et al. Paclitaxel and cisplatin combined with intensity-modulated radiotherapy for upper esophageal carcinoma［J］. Radiat Oncol, 2013, 8: 75. DOI: 10.1186/1748-717X-8-75. ［3］王澜, 孔洁, 韩春, 等. 781例不同部位食管癌三维放疗预后分析［J］. 中华放射肿瘤学杂志, 2013, 22(1): 18-21. DOI: 10.3760/cma.j.issn.1004-4221.2013.01.006. ［4］王玉祥, 祝淑钗, 李娟, 等. 209例食管癌三维适形放疗疗效分析［J］. 中华放射肿瘤学杂志, 2010, 19(2): 101-104. DOI: 10.3760/cma.j.issn.1004-4221.2010.02.004. ［5］沈文斌, 祝淑钗, 李娟, 等. 93例可手术切除食管癌三维适形放疗长期生存分析［J］. 中华放射肿瘤学杂志, 2011, 20(1): 32-35. DOI: 10.3760/cma.j.issn.10044221.2011.01.012. ［6］ Al-Halabi H, Paetzold P, Sharp GC, et al. A contralateral esophagus-sparing technique to limit severe esophagitis associated with concurrent high-dose radiation and chemotherapy in patients with thoracic malignancies［J］. Int J Radiat Oncol Biol Phys, 2015, 92(4): 803-810. DOI: 10.1016/j.ijrobp.2015.03.018. ［7］ Zhu WG, Zhou K, Yu CH, et al. Efficacy analysis of simplified intensity-modulated radiotherapy with high or conventional dose and concurrent chemotherapy for patients with neck and upper thoracic esophageal carcinoma［J］. Asian Pac J Cancer Prev, 2012, 13(3): 803-807. ［8］ Wood MD, Zaki BI, Gordon SR, et al. Trimodality therapy for stage Ⅱ-Ⅲ carcinoma of the esophagus: a dose-ranging study of concurrent capecitabine, docetaxel, and thoracic radiotherapy［J］. J Thorac Oncol, 2013, 8(4): 487-494. DOI: 10.1097/JTO.0b013e3182829bf3. ［9］ Francis DO, Hall E, Dang JH, et al. Outcomes of serial dilation for high-grade radiation-related esophageal strictures in head and neck cancer patients［J］. Laryngoscope, 2015, 125(4): 856-862. DOI: 10.1002/lary.24987. ［10］ Challand T, Thureau S, Dubray B, et al. Esophageal toxicity of radiation therapy: clinical risk factors and management［J］. Cancer Radiother, 2012, 16(5/6): 364371. DOI: 10.1016/j.canrad.2012.07.180. ［11］ Prisman E, Miles BA, Genden EM. Prevention and management of treatment-induced pharyngo-oesophageal stricture［J］. Lancet Oncol, 2013, 14(9): e380-386. DOI: 10.1016/S1470-2045(13)70160-8. ［12］李保奇. 食管癌放疗后食管狭窄的相关因素研究［J］. 中国医学工程, 2013, 21(7): 62-63.

[1]	钱晓涛, 石子宜, 胡格, 吴晓维. Ⅲ~ⅣA期食管鳞状细胞癌放化疗后行巩固化疗的疗效：一项真实世界临床研究[J]. 国际肿瘤学杂志, 2024, 51(6): 326-331.
[2]	杨蜜, 别俊, 张加勇, 邓佳秀, 唐组阁, 卢俊. 局部晚期可切除食管癌新辅助治疗疗效及预后分析[J]. 国际肿瘤学杂志, 2024, 51(6): 332-337.
[3]	高凡, 王萍, 杜超, 褚衍六. 肠道菌群与结直肠癌非手术治疗的相关研究进展[J]. 国际肿瘤学杂志, 2024, 51(6): 376-381.
[4]	范志鹏, 余静, 胡静, 廖正凯, 徐禹, 欧阳雯, 谢丛华. 炎症标志物的变化趋势对一线接受免疫联合化疗的晚期非小细胞肺癌患者预后的预测价值[J]. 国际肿瘤学杂志, 2024, 51(5): 257-266.
[5]	刘静, 刘芹, 黄梅. 基于SMOTE算法的食管癌放化疗患者肺部感染的预后模型构建[J]. 国际肿瘤学杂志, 2024, 51(5): 267-273.
[6]	杨琳, 路宁, 温华, 张明鑫, 朱琳. 炎症负荷指数与胃癌临床关系研究[J]. 国际肿瘤学杂志, 2024, 51(5): 274-279.
[7]	刘萍萍, 何学芳, 张翼, 杨旭, 张珊珊, 季一飞. 原发性脑胶质瘤患者术后复发危险因素及预测模型构建[J]. 国际肿瘤学杂志, 2024, 51(4): 193-197.
[8]	万芳, 杨钢, 李睿, 万启晶. 食管癌患者血清miR-497、miR-383水平及临床意义[J]. 国际肿瘤学杂志, 2024, 51(4): 204-209.
[9]	姚益新, 沈煜霖. 血清SOCS3、TXNIP水平对肝细胞癌TACE治疗预后的预测价值[J]. 国际肿瘤学杂志, 2024, 51(4): 217-222.
[10]	孙维蔚, 姚学敏, 王鹏健, 王静, 贾敬好. 基于血液学指标探讨免疫治疗晚期非小细胞肺癌预后因素及列线图构建[J]. 国际肿瘤学杂志, 2024, 51(3): 143-150.
[11]	李书月, 马辰莺, 周菊英, 徐晓婷, 秦颂兵. 寡转移非小细胞肺癌的放疗进展[J]. 国际肿瘤学杂志, 2024, 51(3): 170-174.
[12]	刘玉兰, 井海燕, 孙静, 宋伟, 沙丹. 胃癌免疫治疗疗效预测及预后标志物的研究进展[J]. 国际肿瘤学杂志, 2024, 51(3): 175-180.
[13]	彭琴, 蔡玉婷, 王伟. KPNA2在肝癌中的研究进展[J]. 国际肿瘤学杂志, 2024, 51(3): 181-185.
[14]	李济时, 陆钊群, 刘俊茹, 吕建勋, 陈霜, 沈琳, 徐志渊, 吴平安. 新辅助放疗联合部分喉切除术治疗喉滑膜肉瘤1例并文献复习[J]. 国际肿瘤学杂志, 2024, 51(2): 123-125.
[15]	陈波光, 王苏贵, 张永杰. 血清胆碱酯酶与炎症标志物在ⅠA~ⅢA期乳腺癌预后中的作用[J]. 国际肿瘤学杂志, 2024, 51(2): 73-82.