| 杜文静,顾晓斌,高献书,等.食管鳞癌诱导化疗联合调强放疗治疗模式探讨及预后分析[J].中华放射医学与防护杂志,2019,39(12):920-925.Du Wenjing,Gu Xiaobin,Gao Xianshu,et al.Discussion on the treatment model and prognostic analysis of esophageal squamous cell carcinoma treated with induction chemotherapy combined with intensity-modulated radiation therapy[J].Chin J Radiol Med Prot,2019,39(12):920-925 |
| 食管鳞癌诱导化疗联合调强放疗治疗模式探讨及预后分析 |
| Discussion on the treatment model and prognostic analysis of esophageal squamous cell carcinoma treated with induction chemotherapy combined with intensity-modulated radiation therapy |
| 投稿时间：2019-03-26 |
| DOI：10.3760/cma.j.issn.0254-5098.2019.12.008 |
| 中文关键词: 食管肿瘤 调强放疗 诱导化疗 序贯 预后 |
| 英文关键词:Esophageal neoplasms IMRT Induction chemotherapy Sequential Prognosis |
| 基金项目:Research Project of Tianjin Medical University Cancer Institute and Hospital (B1715) |
|
| 摘要点击次数: 2933 |
| 全文下载次数: 1220 |
| 中文摘要: |
| 目的 分析食管鳞状细胞癌诱导化疗+调强放疗（IMRT）±巩固化疗模式的疗效及影响因素。方法 回顾性分析2010年1月至2014年8月收治的108例食管鳞癌患者，采用IMRT技术，铂类为基础双药化疗方案，Kaplan-Meier法计算生存率（OS）及局部控制率（LC），Log-rank法检验单因素预后情况，Cox模型多因素预后分析。结果 随访率97.2%，1、3、5年OS分别为76.9%、50.9%和32.3%，1、3、5年LC分别为73.6%、58.5%和54.9%。加入巩固化疗、无巩固化疗的中位OS分别为51、15个月（χ2=5.076，P<0.05）。多因素分析显示N分期、近期疗效和是否巩固化疗是影响OS的因素；近期疗效与LC相关。全组急性3级放射性食管炎、消化道不良反应、骨髓抑制及放射性肺损伤发生率分别为7.4%、6.5％、12.0%和0.9%，均无4级及以上不良反应发生。晚期不良反应主要为放射性肺纤维化，1级和3级均为2例，占1.9%。结论 食管鳞癌行诱导化疗+IMRT±巩固化疗能获得较好疗效，加入巩固化疗可能有助于延长患者生存期，针对无法耐受或拒绝同步放化疗的患者应选择个体化治疗方案。 |
| 英文摘要: |
| Objective To analyze the therapeutic effect and prognostic factors of induction chemotherapy plus intensity-modulated radiotherapy (IMRT) with or without consolidation chemotherapy for esophageal squamous cell carcinoma (ESCC). Methods One hundred and eight patients with ESCC treated between January 2010 to August 2014 were analyzed retrospectively. All patients received IMRT and platinum-based chemotherapy. The overall survival (OS) and local control (LC) rates were calculated using the Kaplan-Meier method and the univariate prognostic analyses were tested by the Log-rank test. The Cox proportional hazard model was used for multivariate prognostic analysis. Results The follow-up rate was 97.2%. The 1-, 3- and 5-year survival rates were 76.9%, 50.9% and 32.3% respectively, and the LC rates were 73.6%, 58.5% and 54.9% respectively. The median OS with and without consolidation chemotherapy were 51 and 15 months (χ2=5.076,P=0.024), respectively. Multivariate analysis showed that clinical N staging, recent curative effect and consolidation chemotherapy were important prognostic factors for OS, and recent curative effect was associated with LC. The rates of acute grade 3 radiation-induced esophagitis, gastrointestinal side effects, myelosuppression and radiation-induced pulmonary injury were 7.4%, 6.5%, 12% and 0.9%, respectively, and no grade 4 occurred. The late toxicity was mainly radiation-induced pulmonary fibrosis. Conclusions Induction chemotherapy plus IMRT with or without consolidation chemotherapy is safe and effective in the treatment of ESCC. The addition of consolidation chemotherapy may help prolong the survival of some patients and further research is necessary. Individualized treatment should be selected for patients who cannot tolerate or refuse concurrent chemoradiotherapy. |
| HTML 查看全文 查看/发表评论 下载PDF阅读器 |
| 关闭 |