局部晚期食管鳞癌术前大分割放疗与常规分割放疗的临床对照研究

发布时间：2018-03-10 19:53

本文选题：食管肿瘤　切入点：术前同步放化疗　出处：《西南医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:评估术前大分割放疗与常规分割放疗同步化疗治疗局部晚期食管鳞癌的疗效和安全性,探讨术前新辅助放疗的放疗分割模式。方法:2002年10月至2011年4月四川省肿瘤医院收治食管癌患者中,有86例符合本次研究入排条件的局部晚期食管鳞癌患者,其中术前大分割放疗组(A组)41例,30Gy/10次/2周,常规分割放疗组(B组)45例,40Gy/20次/4周,化疗方案均使用5-氟尿嘧啶300mg/m2静脉滴注d1-3,顺铂30mg/m2静脉滴注d1-3,21至28天为1个周期,共完成两周期,放化疗同步进行,放化疗结束后3-4周进行手术治疗。手术方式:对于食管胸上段癌常规从颈部、右胸以及上腹部做切口,行食管和胃颈部吻合,并对二野的淋巴结进行清扫。对于食管胸中下段癌则从右胸和上腹部做切口,行食管和胃胸顶部器械吻合,对二野的淋巴结进行清扫。两组临床资料采用χ2检验,生存分析的比较应用kaplan-Meier法,Cox回归模型进行多因素分析。所有的统计检验均应用双侧检验,检验效能0.8,P0.05为差异有统计学意义。主要研究终点为患者的降期情况、R0切除率、p CR率、生存率。次要研究终点为治疗相关的不良反应。结果:A组与B组降期率68.3%和55.6%(P=0.03),R0切除率分别为95.1和88.9%(P=0.02),p CR率分别为31.7%和24.4%(P=0.027),差异有统计学意义。大分割放疗组和常规放疗组1,2,3,4和5年OS分别为78.1%和68.9%,56.1%和48.9%,43.9%和44.4%,31.7%和35.6%,19.5%和15.6%,均无统计学差异(P0.05)。两组患者放射性食管炎、放射性肺炎、白细胞减少、吻合瘘及伤口延期愈合率无明显差异(P0.05)。术前大分割放化疗在降期率、R0切除率、p CR率上较术前常规分割放化疗组有优势(P0.05),两组患者的总生存率及治疗中副反应发生率无统计学差异。单因素分析提示,放疗前分期、体力状态评分、肿瘤长度、放疗后是否降期以及放疗后是否达到病理缓解是影响患者生存的预后因素。多因素分析提示放疗前分期、体力状态评分、放疗后是否降期以及放疗后是否达到病理缓解是影响患者预后的独立因素。结论:术前大分割放疗相对于常规放疗有更好的降期率、R0切除率和p CR率,但两组患者的生存率无差异。术前大分割放疗并不增加患者治疗相关的放射性食管炎、放射性肺炎、白细胞减少、吻合瘘以及伤口延期愈合的发生率,且其治疗周期短、并可以缩短患者住院时间,节约住院费用,更容易为患者所接受。放疗前分期早、放疗后降期和放疗后达到病理缓解的患者预后更优。目前术前大分割放疗及常规分割放疗均可作为局部晚期食管癌术前放疗的分割模式选择方案,临床中应根据患者病情个体化决定具体治疗方式。
[Abstract]:Objective: to evaluate the efficacy and safety of preoperative high-fractionation radiotherapy and conventional fractionated radiotherapy in the treatment of locally advanced esophageal squamous cell carcinoma. Methods: from October 2002 to April 2011, 86 patients with esophageal cancer were admitted to Sichuan Provincial Cancer Hospital. There were 41 patients with 30 Gy / 10 times / 2 weeks in group A and 45 patients with 40 Gy / 20 / 4 weeks in group A and 45 patients with 40 Gy / 20 / 4 weeks in group A and group A received 5-fluorouracil 300 mg / m ~ 2 intravenously for d _ (1-3) and cisplatin 30 mg / m ~ (2) intravenously for d _ (1-321) to 28 days for a period of two cycles. Radiotherapy and chemotherapy were performed at the same time, and surgery was performed 3-4 weeks after the end of radiotherapy and chemotherapy. Operation: for upper thoracic cancer of esophagus, incision was made from neck, right chest and upper abdomen, and esophagus and stomach were anastomosed. The lymph nodes of the second field were dissected. For the middle and lower thoracic carcinoma of esophagus, the incision was made from the right chest and the upper abdomen, the esophagus and stomach thorax were anastomosed, and the lymph nodes of the second field were dissected. The clinical data of the two groups were examined by 蠂 2 test. The survival analysis was compared by kaplan-Meier regression model and Cox regression model. All the statistical tests were carried out with bilateral test. The efficacy of the test was 0.8P 0.05. The main end point of the study was the R0 resection rate and the pCR rate of the patients. Survival rate. The end point of the study was treatment-related adverse reactions. Results the stage reduction rates of group A and group B were 68.3% and 55.60.The R0 resection rates were 95.1 and 88.9 respectively, and the CR rates were 31.7% and 24.40.27, respectively. There was significant difference between the two groups. The OS of the treatment group was 78.1% and 68.9%, respectively, and 43.9% and 44.4%, respectively. There was no statistical difference between the two groups in radiation-induced esophagitis. Radiation pneumonia, leukopenia, There was no significant difference in the rate of anastomotic fistula and wound delayed healing (P 0.05). The rate of R0 resection was higher than that of routine chemotherapy group (P 0.05%). The overall survival rate and side effects occurred in the two groups. There is no statistical difference in the rate. Univariate analysis suggests, The prognostic factors of patients' survival were pre-radiotherapy stage, physical state score, tumor length, whether the stage decreased after radiotherapy and whether the pathological remission was achieved after radiotherapy. Multivariate analysis showed that the stage before radiotherapy and the score of physical condition were the prognostic factors affecting the survival of the patients. Conclusion: compared with conventional radiotherapy, preoperative high fractionation radiotherapy has better R0 resection rate and pCR rate than conventional radiotherapy, and whether or not to achieve pathological remission after radiotherapy is an independent factor affecting the prognosis of the patients, conclusion: compared with conventional radiotherapy, preoperative high fractionation radiotherapy has a better R0 resection rate and a better pCR rate than conventional radiotherapy. But there was no difference in survival rate between the two groups. Preoperative fractionated radiotherapy did not increase the incidence of treatment-related radiation esophagitis, radiation pneumonia, leukopenia, anastomotic fistula and delayed wound healing, and had a short treatment period. It can shorten the duration of hospitalization, save the cost of hospitalization, and be more easily accepted by patients. The prognosis of patients who achieved pathological remission after radiotherapy was better than that after radiotherapy. At present, high fractionation radiotherapy and conventional fractionation radiotherapy can be used as partitioning modes for local advanced esophageal cancer. The specific treatment should be decided according to the individual condition of the patient.
【学位授予单位】：西南医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.1

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