新辅助放化疗在中晚期食管癌临床应用探究.docVIP

新辅助放化疗在中晚期食管癌临床应用探究 　　 【摘要】 目的 探讨新辅助口服优福啶（UFT）+同期超分割放疗对中晚期食管癌近、远期疗效的影响。方法 对术前临床分期为Ⅱ、Ⅲ期，无放化疗、手术禁忌证的147例食管癌患者进行分组研究。研究组51例，术前口服UFT350mg/m 2 ·d，连续2周，同时进行超分割放疗，每次剂量1.5Gy，每日2次，总剂量30Gy，放疗结束2～4周后手术。对照组96例，术前未作治疗。对两组病例近、远期疗效进行比较分析。结果 研究组、对照组根治性切除率分别为86.27%、69.79%;研究组的肿瘤分期、术后局部复发率较对照组显著性降低;手术时间、术中出血量、术后第1日胸腔引流量、术后并发症两组无明显差异。研究组中的3、5年生存率分别为53.25%、36.87%，对照组3、5年生存率分别为43.49%、25.37%。两组的K-M生存曲线差异无显著性（P=0.1001），但研究组中获得缓解的患者较未缓解者显著性提高（P=0.0206）。结论 口服UFT+同期超分割放疗能降低肿瘤分期、局部复发率，提高近期疗效;对长期生存率的提高尚不明确，但获得缓解的患者能显著性提高远期生存率。 　关键词 食管肿瘤 外科学 化学治疗 放射治疗 新辅助治疗 　 The application study of neoadjuvant chemoradiotherapyfor　locallyadvancedesophageal carcinoma 　【Abstract】 Objective To explore the efficacy of oral uracil and tegafur（UFT）concurrent with hyperfractionˉated radiation（HRT）followed by surgery for advanced esophageal carcinoma.Methods 147patients fitted the eligiˉbility criteria were treated oral UFT（350mg/m 2 ·d）with concurrent HRT1.5Gy twice a day to a total dose of30Gy followed by surgery（group A）or immediately surgery（group B）.The efficacy of two treatment gro ups was analyzed.Results The radical resectability of group A and group B were86.27%and69.79%.The tumor stage and postoperˉative local recurrence rate of group A were significantly lowerd.There were no significant differences in operative releˉvant factors and accumulative survival rate between two groups.The accumulative survival rate of patients who achieved partial and complete pathological response was significantly increased.Conclusion Oral UFT concurrent with HRT followed by surgery was feasible and its efficacy was promising，especially in partial and complete pathological response cases.The3，5-year survival benefit remains to be assessed in large well-designed randomized trials.Key words esophageal neoplasm surgery chemotherapy radiotherapy neoadjuvant therapy 　手术切除是食管癌的主要治疗手段，随着现代外科的进步，围手术期处理手段的提高，食管癌切除率较前增加，手术并发症逐渐减少，近期疗效较好;但5年生存率仍在20%左右，远期疗效难以令人满意。近年来对食管癌采取综合治疗获得了一定的效果。新辅助同期放化疗国内外文献报道日益增多，且成为综合治疗模式之一，但具体用法和剂量不统一，对生存