淋巴结转移阳性胸段食管鳞癌术后放疗并同步化疗的临床研究.docVIP

第一作者:陈俊强，联系电话E-mail:junqiangc@163.com 通信地址：350014，福建省福州市福马路马路顶91号福建省肿瘤医院放疗科 淋巴结阳性胸段食管鳞癌术后放化疗的临床研究 陈俊强 潘建基 李建成 刘健 朱坤寿 陈明强 王捷忠 钱飞宇 郑雄伟 【摘要】 目的 对淋巴结阳性胸段食管鳞癌术后放化疗与术后放疗进行回顾性分析，观察其毒副反应及疗效。方法 选择首程治疗行胸段食管鳞癌三野淋巴结清扫根治术，术后病理有淋巴结转移、无远处血行转移的患者304例，其中术后放疗组140例，术后放化疗组164例。术后放疗剂量50Gy，化疗方案为顺铂加紫杉醇，21天为一周期，平均每例2.35个周期。结果 术后放化疗组和术后放疗组3年的总生存率和无瘤生存率分别为65.7%和52.8% (χ2=6.90，P =0.009)和62.5%和52.8% (χ2=4.75，P =0.029)，术后放化疗组降低了锁骨上区淋巴结转移率、远处转移率和总复发转移率（P ＜0.05），但早期毒副反应在中性粒细胞减少、放射性食管炎和胃肠道反应术后放化疗组明显重于术后放疗组（P ＜0.05），晚期并发症两组无差异（P＞0.05）。结论 淋巴结阳性胸段食管鳞癌术后放化疗，能够提高生存率和无瘤生存率，降低锁骨上区淋巴结转移率、远处转移率和总复发转移率，早期毒副反应重于单纯术后放疗，但患者能耐受治疗。 【关键词】 食管肿瘤/外科学；食管肿瘤/放射疗法；化学疗法；毒副反应；生存率 Clinical study of postoperative chemoradiotherapy of thoracic esophageal squamous cell carcinoma with positive lymph nodes CHEN Jun-qiang, PAN Jian-ji, LI Jian-cheng, LIU JIan， ZHU Kun-shou,CHEN Ming-qiang, WANG Jie-zhong,QIAN Fei-yu,ZHENG Xiong-wei. Department of Radiation Oncology，The Teaching Hospital of Fujian Medical University ,Fujian Provincial Tumor Hospital, Fuzhou 350014, China [Abstract] Objective To retrospectively ananlyze the treatment results and the side effects of postoperative chemoradiotherapy and the simple postoperative radiotherapy of thoracic esophageal squamous cell carcinoma (EPC) with positive lymph nodes. Methods 304 patients of thoracic EPC were initially treated with three-field lymphadenectomy, with pathological positive lymph nodes and without hemocircular distant metastases; and they were randomly divided into two groups: 140 patients of the simple postoperative radiotherapy(RT) and 164 patients of postoperative chemoradiotherapy (CRT). The median total dose was 50Gy. The regimen of concurrent chemotherapy included cisplatin and taxol, and the intermission was 21 days; the median cycles were 2.35. Results The 3-year overall survival rates were 65.7% of CRT and 52.8% of RT (χ2=6.90，P =0.009), and The 3-year desease-free survival rates were 62.5% of CRT and 52.8% of RT (χ2=4.75，P =0.029), CRT decrease