调强放疗联合紫杉醇及奈达铂同步化疗治疗食管癌的临床分析

发布时间：2018-03-09 14:57

本文选题：调强放疗　切入点：三维适形放疗　出处：《河南大学》2015年硕士论文　论文类型：学位论文

【摘要】：研究目的:我院开展三维适形放疗联合化疗治疗食管癌10余年,取得了较好的临床效果,积累了丰富临床经验,但调强放疗联合紫杉醇及奈达铂化疗治疗食管癌的临床疗效尚未见报告,本研究搜集我院80例食管癌患者,旨在分析食管癌患者接受调强放疗与三维适形放疗联合紫杉醇及奈达铂同步化疗的近期疗效及耐受性。研究方法:本研究通过收集2012年9月至2014年12月于河南大学第一附属医院就诊80例食管癌患者,病理为食管鳞状细胞癌,无放化疗禁忌症,且不能手术或不愿手术,分期按UICC食管癌国际分期原则,没有穿孔前表现(包括龛影、癌性溃疡、弯曲成角畸形),心、肝、肾功能无明显异常,骨髓状况正常,无重大内科疾患,KPS≥70分;相关检查提示病变局限食管;评估生存时间不少于半年,随机分为IMRT联合紫杉醇及奈达铂方案放化疗组(实验组)和3D-CRT联合紫杉醇及奈达铂方案放化疗组(对照组),每组40例,两组被试的一般情况比较结果显示,无明显统计学差异(P0.05);放疗方面:处方剂量为95%的PTV,每周放疗5次,总剂量64 Gy/32f/6.4周。重要脏器剂量保护:肺V2030%,V3020%,脊髓最大剂量(Dmax)45Gy;化疗方面:生理盐水250ml中配置奈达铂40mg/m2静脉输液,第1,8天;生理盐水500ml中配置紫杉醇80mg/m2静脉输液,用药前12h、6h各口服地塞米松片7.5mg,应用苯海拉明20mg肌注,生理盐水250ml中配置雷尼替丁100mg静脉输液预防变态反应在用药前30分钟给予,第1,8天,放疗第一天开始化疗,以上方案每4周重复1次,化疗3-4周期,定期复查肝肾功能,若有肝功能增高症状,可口服保肝药物或者静脉输液;若有肾功能增高,应用改善肾脏微循环药物输液治疗,密切观察骨髓情况。放化疗尽可能同步进行。常规采用多功能监护仪监测生命体征变化。比较两种治疗方法,研究调强放疗对比三维适形放疗联合紫杉醇及奈达铂方案同步化疗的近期疗效及耐受性。研究结果:80例患者全部按计划完成治疗,其中有3例患者因III度骨髓抑制使治疗时间延长1周。疗效:全部治疗结束后1月,评判疗效主要依据治疗前后胸部CT,X线钡餐片的改变。根据WHO肿瘤近期疗效标准评价,分为CR、PR、SD、PD,近期有效率以CR+PR计算。实验组有效率(CR+PR)为90.0%(36/40)高于对照组的80.0%(32/40),两组差异不显著(χ2=1.569,P0.05);毒副反应:放疗方面,以美国肿瘤放射治疗协作组早期放射反应依据评判;化疗方面,毒副反应按世界卫生组织制定的抗肿瘤药物急性与亚急性毒性反应分级标准评定。两组毒副反应均以急性放射性食管炎、白细胞减少及血小板减少为主。两组急性放射性食管炎按RTOG标准多为1,2级,并且两组无明显差别,无统计学意义(P0.05)。患者对放化疗引起的毒副反应经积极对症治疗后都能承受,都完成治疗。我们在设计实验时应用的化疗药物剂量适中,并非较大剂量,并且及时予以对症及营养支持治疗,所以化疗引起的副反应是能够承受的,以确保整个治疗的完整性和连续性,实验组在肺V20、V30方面对比对照组有优势(P0.05),并且实验组的急性放射性肺炎发生率下降(P0.05)。结论:1,本研究采用调强放疗或三维适形放疗,化疗手段为奈达铂及紫杉醇方案。在增强肿瘤剂量的均匀性,加大肿瘤剂量方面调强放疗似乎更佳,而且还能减少肿瘤周围重要脏器的剂量,近期治疗效果佳;2,研究数据提示实验组的V20,V30显著优于对照组,实验组的放射性肺炎发生率下降。3,目前局部中晚期不能手术的食管癌应用同步放化疗是标准治疗手段,同步放化疗治疗食管癌既有明显的相互增敏作用,两种治疗协同起效,增加了近期治疗效果及生活质量。
[Abstract]:Objective: Our Hospital of three-dimensional conformal radiotherapy combined with chemotherapy in the treatment of esophageal cancer for more than 10 years, has better clinical effect, has accumulated rich clinical experience, but the clinical efficacy of intensity-modulated radiotherapy combined with paclitaxel and nedaplatin in the treatment of esophageal cancer has not been reported, this study collected in our hospital 80 cases of patients with esophageal cancer. Aimed at the analysis of patients with esophageal carcinoma underwent IMRT with three-dimensional conformal radiotherapy combined with paclitaxel and nedaplatin chemotherapy efficacy and tolerability. Methods: in this study, the First Affiliated Hospital of Henan University in 80 cases of esophageal cancer patients by collecting from September 2012 to December 2014, the pathology of esophageal squamous cell carcinoma, and no chemotherapy contraindications. No surgery or refused operation, according to the UICC staging of esophageal cancer staging international principle, no perforation before the performance (including niche, cancerous ulcer, bending deformity), heart, liver, renal function was not significantly different Often, the bone marrow condition is normal, no major diseases, KPS = 70; related examination showed localized lesions of esophageal; evaluate the survival time of less than half a year, were randomly divided into IMRT combined with paclitaxel and nedaplatin chemotherapy group (experimental group) and 3D-CRT combined with paclitaxel and nedaplatin program chemotherapy group (control group), 40 cases in each group. The general situation of the two groups of subjects comparison showed that no statistically significant difference (P0.05); radiotherapy: the prescription dose was 95% PTV, 5 times a week of radiotherapy, total dose of 64 Gy/32f/6.4 weeks. The dose of important organs: lung protection V2030%, V3020%, maximum dose of spinal cord (Dmax) 45Gy chemotherapy; nedaplatin: intravenous infusion of saline 250ml 40mg/m2 configuration, the first 1,8 days; paclitaxel intravenous infusion of saline 500ml 80mg/m2 configuration, 12h 6h before treatment, the oral administration of Dexamethasone Tablets 7.5mg, application of Hella Ming 20mg intramuscular injection, Rene saline 250ml configuration Cimetidine 100mg intravenous infusion to prevent allergy medication in 30 minutes before, the first 1,8 days, the first day of radiotherapy chemotherapy, the above scheme was repeated every 4 weeks for 1 times, 3-4 cycles of chemotherapy, liver and kidney function regularly, if liver function increased symptoms, oral or intravenous infusion of hepatoprotective drugs; if renal function increased application of improved renal microcirculation, drug infusion therapy, close observation of bone marrow. Chemotherapy as much as possible simultaneously. By using conventional monitoring of vital signs multi function. Comparison of two kinds of treatment methods of IMRT compared with three-dimensional conformal radiotherapy combined with paclitaxel and nedaplatin chemotherapy efficacy and tolerability study. Results: all 80 patients completed the treatment as planned, including 3 patients with III myelosuppression that prolonged treatment for 1 weeks. The curative effect: after all the treatment in January, mainly based on the evaluation of the curative effect before treatment After the chest CT, X-ray barium X-ray changes. According to a recent WHO tumor evaluation standard of curative effect, divided into CR, PR, SD, PD, the short-term effective rate was calculated with the CR+PR. The effective rate of experimental group (CR+PR) 90% (36/40) higher than 80% in the control group (32/40), the two groups had no significant difference (x2 2=1.569, P0.05); toxicity of radiotherapy, the Radiation Therapy Oncology Group on the basis of early radiation response evaluation; chemotherapy, acute and subacute toxicity toxicity by WHO to develop anticancer drug classification criteria. The toxicity of the two groups were with acute radiation esophagitis, leukopenia and platelet decreased. Two groups of acute radiation esophagitis according to the standard of RTOG for 1,2, and the two group had no significant difference, no statistical significance (P0.05). The adverse reaction caused by chemotherapy of patients after symptomatic treatment can take complete treatment. We set up in The application of moderate dose chemotherapy meter experiment, not large dose, and timely symptomatic and supportive therapy, so the side effects caused by chemotherapy is able to bear, in order to ensure the integrity and continuity of the treatment, the experimental group in the lung V20, V30 compared with the advantage of control group (P0.05), and the experimental group decreased the incidence of acute radiation pneumonitis (P0.05). Conclusion: 1. This study uses intensity-modulated radiotherapy and three-dimensional conformal radiotherapy, chemotherapy for nedaplatin and paclitaxel. In enhancing the uniformity of tumor dose, increase the tumor dose on intensity-modulated radiotherapy seems to be better, but also reduce the visceral tumors the dosage, therapeutic effect is good; 2, the research data showed that the experimental group V20, V30 was significantly better than the control group, the incidence of radiation pneumonitis in experimental group decreased by.3, the application of synchronous esophageal cancer in locally advanced inoperable Chemoradiotherapy is a standard treatment. Concurrent chemoradiotherapy has obvious sensitizing effects on esophageal cancer. The two treatments synergy and increase the short-term therapeutic effect and quality of life.

【学位授予单位】：河南大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R735.1

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