紫杉醇联合顺铂与5-Fu联合顺铂同步放疗治疗食管癌的疗效观察

发布时间：2018-11-08 08:47

【摘要】：研究背景食管癌在我国死亡率高,且发病率与死亡率仍不断攀升。由于食管癌单纯依靠手术或单纯放疗总体生存率低,故同步放化疗已成为中晚期食管癌标准治疗方案。目前大多数临床研究表明同步放化疗局部控制率及生存率优于单纯放疗,传统同步放疗的化疗方案为5-fu联合顺铂,但同步放化疗毒副反应较明显,尤其是消化道症状较明显,其次表现为骨髓抑制。为了进一步取得更好疗效,临床上需要探索新的有效的同步放化疗方案。太平洋红豆杉树树皮中提取的有效抗肿瘤药物紫杉醇,具有独特的微管稳定作用,已被临床已证实对多个实体肿瘤均有效,如肺癌、乳腺癌以及消化道肿瘤等,是广谱抗癌药物。但是紫杉醇存在神经、心脏毒性,骨髓抑制等剂量限制性毒性反应。目的1、了解紫杉醇联合顺铂同步放疗方案的疗效以及毒副反应。2、分析比较紫杉醇联合顺铂与顺铂联合5-Fu(5-fluorouracil)同步放疗治疗食管癌的临床疗效以及不良反应。3、探讨如何优化食管癌同步放化疗方案。方法:收治病理组织学检查确诊的食管癌患者53例,随机分为两组进行同步放化疗:紫杉醇(125mg/m~2,dl)联合顺铂(20mg/m~2,d1-3)同步放疗组(TP组,25例);5-Fu(500 mg/m~2,d1-5)联合顺铂(20 mg/m~2,d1-4)同步放疗组(DF 组,28例)。两组方案28天为1周期,放疗第4周时重复第2个疗程。放射治疗剂量为56-60 Gy,2 Gy/次,5次/每周。比较二组局部控制率、1年生存率、不良反应发生率。用Kaplan-Meier法计算生存率。结果1、TP组及DF组局部控制率分别为84%和89.29%;1年生存率分别为76%和85.71%,两组生存率比较无明显统计学差异(P0.05)。2、两组呕吐、放射性肺炎发生率相似(P0.05);紫杉醇联合顺铂同步放疗组放射性食管炎发生率(32%)低于5-Fu联合顺铂同步放疗组(53.57%),但两组差异无统计学意义(P0.05)。两组血液毒副反应均较明显,且紫杉醇联合顺铂同步放疗组发生率高于另一组,两组之间差异有统计学意义(P=0.013)。其中重度骨髓抑制紫杉醇联合顺铂同步放疗组发生率为20%,顺铂联合5-Fu同步放疗组发生率为7.14%。结论:1、紫杉醇联合顺铂组与顺铂联合5-Fu组两种方案治疗食管癌近期疗效相仿,紫杉醇联合顺铂组放射性食管炎发生率较低,同步放疗耐受性较佳;2、紫杉醇联合顺铂方案可以作为顺铂联合5-Fu方案的替代方案治疗,但紫杉醇联合顺铂方案药物剂量应用仍需进一步优化。
[Abstract]:Background the mortality of esophageal cancer in China is high, and the morbidity and mortality are still rising. Due to the low overall survival rate of esophageal carcinoma by surgery or radiotherapy alone, concurrent radiotherapy and chemotherapy has become the standard treatment for advanced esophageal cancer. At present, most clinical studies show that the local control rate and survival rate of concurrent radiotherapy and chemotherapy are better than that of radiotherapy alone. The traditional chemotherapy regimen of concurrent radiotherapy is 5-fu combined with cisplatin, but the side effects of concurrent radiotherapy and chemotherapy are obvious. In particular, digestive tract symptoms were more obvious, followed by bone marrow suppression. In order to obtain better curative effect, it is necessary to explore a new and effective regimen of concurrent radiotherapy and chemotherapy. Paclitaxel, an effective antitumor drug extracted from the bark of Taxus chinensis, has a unique microtubule stabilization effect and has been clinically proven to be effective for many solid tumors, such as lung cancer, breast cancer and digestive tract tumors. It is a broad-spectrum anticancer drug. However, paclitaxel has neurotoxicity, cardiac toxicity, bone marrow suppression and other dose limiting toxic reactions. Objective 1 to investigate the efficacy and side effects of paclitaxel combined with cisplatin concurrent radiotherapy. The clinical efficacy and adverse reactions of paclitaxel combined with cisplatin and cisplatin combined with 5-Fu (5-fluorouracil) in the treatment of esophageal carcinoma were analyzed and compared. Methods: Fifty-three patients with esophageal cancer diagnosed by histopathological examination were randomly divided into two groups: paclitaxel (125 mg / ml) combined with cisplatin (20 mg / m ~ (2) D ~ (-1) in TP group (n = 25); 5-Fu (500 mg/m~2,d1-5) combined with cisplatin (20 mg/m~2,d1-4) simultaneous radiotherapy group (DF group, 28 cases). The two groups received one cycle on 28 days and repeated the second course of treatment at the fourth week of radiotherapy. The dose of radiotherapy was 56-60 Gy,2 Gy/, 5 times a week. The local control rate, 1-year survival rate and adverse reaction rate were compared between the two groups. The survival rate was calculated by Kaplan-Meier method. Results 1the local control rates of TP group and DF group were 84% and 89.29%, respectively. The 1-year survival rate was 76% and 85.71%, respectively. There was no significant difference between the two groups (P0.05). 2. The incidence of vomiting and radiation pneumonia was similar between the two groups (P0.05). The incidence of radiation esophagitis in paclitaxel combined with cisplatin simultaneous radiotherapy group (32%) was lower than that in 5-Fu combined cisplatin concurrent radiotherapy group (53.57%), but there was no significant difference between the two groups (P0.05). The incidence rate of paclitaxel combined with cisplatin simultaneous radiotherapy group was higher than that of the other group, the difference between the two groups was statistically significant (P0. 013). The incidence of severe bone marrow suppression paclitaxel combined with cisplatin concurrent radiotherapy was 20 and that of cisplatin combined with 5-Fu was 7.14. Conclusion: 1. The efficacy of paclitaxel combined with cisplatin and cisplatin combined with 5-Fu in the treatment of esophageal carcinoma is similar. The incidence of radiation esophagitis in paclitaxel combined with cisplatin group is lower and the tolerance of concurrent radiotherapy is better; 2. Paclitaxel combined with cisplatin can be used as an alternative to cisplatin combined with 5-Fu, but the dosage of paclitaxel combined with cisplatin still needs to be optimized.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.1

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