替加氟同步调强放疗在中晚期食管癌治疗中的临床研究

发布时间：2018-12-19 10:24

【摘要】：本研究试图研究调强放疗和三维适形放疗两种放疗方法之间、顺铂联合5-氟脲嘧啶与替加氟两种化疗方法之间，，治疗食管癌（EC）的在近期疗效和毒副反应等方面的差异；同时通过替加氟同步调强放疗治疗局部中晚期食管癌，对其近期疗效进行观察，对其不良反应和患者的耐受性进行研究，尝试将其作为中晚期EC的综合治疗方案进行临床验证，试验结果良好。先选取6例接受放疗的患者，调强放疗和三维适形放疗各3例，分析比较其放射剂量的分布情况；选取2顺铂联合5-氟脲嘧啶与替加氟化疗患者各20名，比较两组的近期疗效和毒副方应的差异；最后选取57例中晚期EC患者，分成单纯手术治疗组、单纯放疗组和替加氟化疗同步调强放疗组三个组进行对比研究，收集临床治疗和随访观察数据，比较近期疗效、随访及一年生存率、放化疗不良反应监测以及生存质量改善指标等数据在三组间的差别。基于剂量分布、保护正常组织功能和靶区适形性等分析发现，IMRT比3D-CRT表现更为优秀。替加氟比DDP及5-FU有较好的近期疗效，未达到统计意义上的差异显著性，但替加氟组的毒副反应相比其它的组要轻。此外，在近期疗效及一年生存率上，替加氟同步调强放疗组优于常规手术组和单纯放疗组，分别为90.0%和61.3%，而常规手术组为66.7%和41.2%，常规放疗组为78.9%和46.8%，试验结果体现了放化疗协同效应的优越性。在不良反应监测上，替加氟同步调强放疗与常规放疗组对比无差异。而替加氟同步调强放疗方法对患者近期生存质量的改善比较明显，在放射性食管炎、进食情况、KPS生活质量评分、血红蛋白浓度上均优于其他两组。本研究证明了替加氟同步调强放疗在中晚期EC治疗中有较好的近期疗效和一年生存率，而且副反应并未进一步提高，可以为患者耐受，因此值得作为中晚期EC的一种新的治疗手段进一步尝试。
[Abstract]:The purpose of this study was to study the difference between IMRT and 3D conformal radiotherapy, cisplatin combined with 5-fluorouracil and tegafur in the treatment of esophageal cancer (EC) in the short term and side effects. At the same time, through the treatment of local advanced esophageal carcinoma with Tegafur synchronous intensity modulated radiotherapy, the short-term curative effect was observed, and the adverse reactions and patient tolerance were studied. The test results are good. First, 6 patients received radiotherapy, 3 patients received intensity modulated radiotherapy (IMRT) and 3 patients were treated with three dimensional conformal radiotherapy (3D conformal radiotherapy), and the distribution of radiation dose was analyzed and compared. 20 patients with cisplatin combined with 5-fluorouracil and 20 patients with tigafur chemotherapy were selected to compare the short-term curative effect and the difference of toxicant prescription between the two groups. Finally, 57 patients with advanced EC were divided into three groups: simple operation group, radiotherapy group and tigafur chemotherapy combined with intensity modulated radiotherapy group. The clinical treatment and follow-up observation data were collected to compare the short-term curative effect. The data of follow-up and one-year survival rate, adverse reaction monitoring of radiotherapy and chemotherapy, and quality of life improvement were different among the three groups. Based on the analysis of dose distribution, protection of normal tissue function and target conformability, it was found that IMRT performed better than 3D-CRT. Tegafur had better short-term curative effect than DDP and 5-FU, but the toxicity of tigafur group was lighter than that of other groups. In addition, in terms of short-term curative effect and 1-year survival rate, tigafur synchronous intensity modulated radiotherapy group was superior to conventional surgery group and simple radiotherapy group (90.0% and 61.3%, respectively), while conventional operation group was 66.7% and 41.2%, respectively. The conventional radiotherapy group was 78.9% and 46.8% respectively. The results showed the superiority of the synergistic effect of radiotherapy and chemotherapy. In adverse reaction monitoring, there was no difference between Tegafur simultaneous intensity modulated radiotherapy group and conventional radiotherapy group. The quality of life of patients with radiation esophagitis, food intake, KPS quality of life score and hemoglobin concentration were better than those of other two groups in terms of radiation esophagitis, food intake, quality of life score and hemoglobin concentration. This study demonstrated that Tegafur synchronous intensity modulated radiotherapy has good short-term efficacy and 1-year survival rate in the treatment of intermediate and advanced EC, and the side effects have not been further improved and can be tolerated by patients. Therefore, it is worthy of further attempt as a new treatment for EC in middle and late stage.
【学位授予单位】：清华大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R735.1;R730.55

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