中华放射医学与防护杂志

蒋晨雪,陈武成,韩水云,等.三联疗法对比根治性放化疗治疗局部晚期食管鳞癌[J].中华放射医学与防护杂志,2018,38(3):192-196.Jiang Chenxue,Chen Wucheng,Han Shuiyun,et al.Comparison of efficacy between trimodality and chemoradiation therapy alone in treatment of locally advanced esophageal squamous cell carcinoma[J].Chin J Radiol Med Prot,2018,38(3):192-196

三联疗法对比根治性放化疗治疗局部晚期食管鳞癌

Comparison of efficacy between trimodality and chemoradiation therapy alone in treatment of locally advanced esophageal squamous cell carcinoma

投稿时间：2017-11-24

DOI：10.3760/cma.j.issn.0254-5098.2018.03.006

中文关键词: 食管鳞癌三联疗法术前放化疗术后放化疗根治性放化疗

英文关键词:Esophageal squamous cell carcinoma Trimodality therapy Preoperative chemoradiotherapy Postoperative chemoradiotherapy Definitive chemoradiotherapy

基金项目:

作者	单位	E-mail
蒋晨雪	325035 温州, 温州医科大学第一临床医学院
陈武成	325035 温州, 温州医科大学第一临床医学院
韩水云	310022 杭州, 浙江省肿瘤医院放疗科
朱湘	310022 杭州, 浙江省肿瘤医院放疗科
孙晓江	310022 杭州, 浙江省肿瘤医院放疗科
许亚萍	325035 温州, 温州医科大学第一临床医学院	xuyaping1207@163.com
陈奇勋	310022 杭州, 浙江省肿瘤医院胸外科
毛伟敏	310022 杭州, 浙江省肿瘤医院胸外科

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中文摘要:

目的对比分析三联疗法和根治性放化疗对局部晚期可手术食管鳞癌患者的疗效。方法回顾性分析局部晚期可手术食管鳞癌124例，根据手术方法分为三联疗法组（54例）和根治性放化疗组（70例）。三联疗法组为手术联合新辅助或术后辅助放化疗，根治性放化疗组仅接受放化疗。评估两种治疗方法对肿瘤局部控制率、3年生存率及治疗相关死亡的影响。结果三联疗法组和根治性放化疗组的局部复发率分别为18.5%和35.7%，差异有统计学意义（χ²=4.445，P<0.05）；三联疗法组和根治性放化疗组3年无疾病进展生存率（PFS）分别为65.3%（95%CI 50.7~80.5）和31.9%（95%CI 19.6~44.2），差异有统计学意义（P<0.05）；3年总生存率（OS）分别为66.3%（95%CI 43.0~89.6）和34.4%（95%CI 21.1~47.7），差异有统计学意义（P<0.05）。三联疗法组和根治性放化疗组的治疗相关死亡率分别为1.9%和2.9%，两组比较，差异无统计学意义（P>0.05）。亚组分析显示根治性放化疗组中接受放疗剂量50~50.4 Gy和>50.4 Gy的患者3年生存率分别为39.9%（95%CI 18.5~61.3）和31.5%（95%CI 14.8~48.2），差异无统计学意义（P>0.05）。结论与根治性放化疗相比，三联疗法有更好的局部控制率、PFS和OS，而治疗相关死亡率相似。另外，增加放疗剂量并不能作为代替手术的治疗方法。

英文摘要:

Objective To compare the efficacy of trimodality therapy and chemoradiation therapy(CRT) alone in patients with locally advanced resectable esophageal squamous cell carcinoma (SCC). Methods A total of 124 cases with locally advanced resectable esophageal SCC were retrospectively analyzed and classified into 2 groups. Fifty-four cases in trimodality group were treated with surgery and preoperative chemoradiation, while 70 cases in CRT alone group only received radiation and chemotherapy. Local tumor control, 3-year survival and treatment-related mortality were assessed. Results The local recurrent rate of the resected patients was 18.5% in trimodality group and 35.7% in CRT alone group, respectively(χ²=4.445, P<0.05). The 3-year progression-free survival (PFS) was 65.3% (95%CI 50.7-80.5) in trimodality group and 31.9% (95%CI 19.6-44.2) in CRT alone group (P<0.05), while the overall survival (OS) 66.3%(95%CI 43.0-89.6) and 34.4%(95%CI 21.1-47.7), respectively(P<0.05). Treatment-related mortality was 1.9% in trimodality group and 2.9% in CRT alone group (P>0.05). For CRT alone group, the sub-group analysis showed that there was no statistically significant difference in the 3-year OS between patients who received 50-50.4 Gy and those who received the dose over 50.4 Gy (39.9% 95%CI 18.5-61.3 vs. 31.5% 95%CI 14.8-48.2, P>0.05). Conclusions Compared with CRT alone, trimodality therapy showed the superior local control, PFS and OS, with similar treatment-related mortality in the treatment of patients with SCC of esophagus. The role of surgery could not be replaced by CRT alone even with the augment of radiation dose.

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