食管癌术前放化疗疗效分析_医学论文.docVIP

食管癌术前放化疗疗效分析_医学论文 食管癌术前放化疗疗效分析_医学论文 作者：王珏 孙成超 吴式张萍 林超西 【摘要】 目的 探讨术前同步放化疗治疗食管癌的疗效及围手术期并发症。方法 2000年12月至2006年8月，26例食管癌初治患者，采用常规放射野治疗，肿瘤量40Gy，在放疗的第1周和第4周均给予常规剂量紫杉醇和铂类化疗2个疗程，休息4～6周后手术。结果 放化疗并发症主要为骨髓抑制，肺部损害，食管炎。放化疗组的完全病理缓解率为38.46%，急性毒副反应仅1～2级，癌肿局部控制率73.08%，远处转移率26.92%，3年生存率62.96%，5年生存率54.56%，无病生存率63.82％。多因素分析显示影响食管癌生存率的因素有病变长度、肿瘤浸润深度、淋巴结转移情况。术前放化疗对于手术难度没有增加，术后并发症主要是肺部并发症。结论 应用术前同步放化疗治疗食管癌是安全的，取得了较好的疗效。 【关键词】 食管癌 手术 放射疗法 化学疗法　　【Abstract】 Objective To evaluate the tolerance and the short-term outcome of preoperative chemoradiotherapy for patients with locally advanced esophageal carcinoma, to observe effects of preoperative chemoradiotherapy on tumor resection rate, incidence of complications after surgery. Methods From December 2000 to August 2002, twenty-Six consecutive patients with locally advanced esophageal carcinomas were entered into this study. Each involved radiotherapy, in a dose of 40Gy.The chemotherapy consisted of Paclitaxel and Cisplatin. The chemotherapy was administered in continuous infusion for the first week and the fourth week. After completion of chemoradiotherapy, clinical restaging was performed. Esophagectomy and lymphadenectomies were performed 4-6 weeks after chemoradiotherapy. Results Twenty-five patients completed the planned chemoradiotherapy. The toxicities of chemoradiotherapy such as myelotoxicity, pulmonary toxicity, esophagitis were grade I or II. The pathological complete response rate was 38.46%, the three years survival rate of combine therapy and surgery alone was 62.96%,five years survival rate was 54.56% ，the local control ratio was 73.08%, the distant metastasis rate was 26.92%.The disease free survival（DFS）rate was 63.82%.These prognosis factors were found to influence survival in a multivariate analysis: the location of the tumor, the disease stage, the length of the tumor, and the lymphoid node metastasis. Conclusions The results of this study suggest that the strategy of chemoradiotherapy followed by surgery is safe. Preoperati