关键词: 食管肿瘤, 肿瘤复发, 局部, 放射疗法, 调强适形, 预后, 雷替曲塞

Abstract: Objective  To evaluate the efficacy, safety and prognostic factors of raltitrexed plus nedaplatin combined with concurrent radiotherapy for locoregional recurrence of esophageal squamous cell carcinoma after surgery. MethodsBetween October 2011 and March 2015, 54 patients with locoregional recurrence of esophageal carcinoma after surgery in Sichuan Cancer Hospital and Institute were treated with raltitrexed plus nedaplatin combined with concurrent radiotherapy. The patients were irradiated with a dose of 6066 Gy in 3033 fractions. At least 2 cycles of concurrent chemotherapy were administered during radiotherapy, with 3 mg/m2 raltitrexed and 80 mg/m2 nedaplatin on the first day, every 21 days. ResultsThe complete response rate was 7.4% (4/54), and the partial response rate was 70.4% (38/54). The total response rate was 77.8%. The 1, 2, 3year survival rates and median survival time were 62.9%, 27.5%, 12.2% and 18.0 months, respectively. The 1-, 2-year progressionfree survival rates and median progressionfree survival time were 33.9%, 12.6% and 8.0 months, respectively. In univariate analysis, the shorttime curative effect (χ2=3.935, P=0.047), the site of recurrence (χ2=11.280, P=0.001), postoperative stage (χ2=5.141, P=0.023) were related to the survival rate. COX multiple factors regression analysis showed that the shorttime curative effect (χ2=6.044, P=0.014), the site of recurrence (χ2=7.019, P=0.013), postoperative stage (χ2=3.404, P=0.036) were independent prognostic factors for survival. The incidence rates of ≥grade 3 leukopenia, hypochromia, thrombocytopenia were 24.1%, 3.7% and 13.0%, respectively. Gastrointestinal adverse reactions were grade 12 nausea and vomiting and acute diarrhea, and the incidence rates were 18.5% and 7.4%, respectively. The incidence rates of grade 12 acute radiationinduced esophagitis and acute radiationinduced pneumonia were 27.8% and 20.4%, respectively. ConclusionRaltitrexed plus nedaplatin combined with concurrent radiotherapy can enhance the response rate and prolong the survival of patients with locoregional recurrence of esophageal carcinoma after surgery, which has mild toxicity and is worthy of randomized controlled clinical study. After treatment, the recent curative effect is good, and the prognosis of patient with recurrence of single part and early postoperative pathologic staging is better.

Key words: Esophageal neoplasms, Neoplasm recurrence, local, Radiotherapy, intensity-modulated, Prognosis, Raltitrexed