周剂量多西他赛联合顺铂同步放疗治疗不能手术的晚期食管癌的临床疗效
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摘要
目的观察周剂量多西他赛加顺铂(TP方案)化疗联合同步放疗治疗晚期食管癌的疗效和不良反应。方法不能手术的晚期食管癌患者120例随机均分为两组:观察组采用TP方案化疗,对照组采用顺铂联合氟尿嘧啶(PF方案)化疗,两组同步放疗为每次1.8～2.0Gy,5次/周,总剂量54～66Gy。比较两组疗效和不良反应发生情况。结果观察组患者的有效率和疾病控制率均高于对照组(65.0%vs.50.0%和95.0%vs.90.0%)(P<0.05)。观察组的中位无进展生存时间和总生存期均高于对照组(18个月vs.14个月和31个月vs.25个月)(P<0.05)。观察组的1年和2年生存率均高于对照组(81.7%vs.76.7%和58.3%vs.41.7%)(P<0.05)。观察组Ⅲ、Ⅳ度恶心、呕吐发生率低于对照组,Ⅲ、Ⅳ度骨髓抑制和Ⅰ、Ⅱ度神经毒性发生率高于对照组(P<0.05)。结论与PF方案化疗比较,周剂量TP方案化疗联合同步放疗治疗不能手术的晚期食管癌的临床疗效较好。
Objective To observe the clinical efficacy and adverse responses of weekly dosage of docetaxel combined with cisplatin(TP regime)and concurrent radiotherapy in the treatment of inoperable advanced esophageal carcinoma.Methods A total of 120 patients with locally advanced esophageal carcinoma was divided into two groups with 60 cases each.The patients in group A were treated with TP regime and concurrent radiotherapy of 54-66 Gy(1.8-2.0 Gy×5 times per week)and those in group B were treated with cisplatin combined with fluorouracil(PF regime).The clinical efficacy and adverse responses were compared between two groups.Results The effectiveness rate and disease control rate of group A were higher than those of group B(65.0%vs.50.0%and 95.0%vs.90.0%)(P<0.05).The median progression-free survival time and overall survival time of group A were longer than those of group B(18 months vs.14 months and 31 months vs.25 months)(P<0.05).The 1-year and 2-year survival rates of group A were higher than those of group B(81.7% vs.76.7% and 58.3% vs.41.7%)(P<0.05).The incidence rates of degreeⅢ-Ⅳ nausea and vomiting were lower,but those of degreeⅠ-Ⅱ neurotoxicity and degreeⅢ-Ⅳ myelosuppression were higher,in group A than those in group B(P<0.05).Conclusion Compared to PF regime,the weekly dosage of TP regime combined with concurrent radiotherapy has better clinical efficacy in the treatment of the patients with locally advanced esophageal cancer who lost the chance of surgery.
Objective To observe the clinical efficacy and adverse responses of weekly dosage of docetaxel combined with cisplatin(TP regime)and concurrent radiotherapy in the treatment of inoperable advanced esophageal carcinoma.Methods A total of 120 patients with locally advanced esophageal carcinoma was divided into two groups with 60 cases each.The patients in group A were treated with TP regime and concurrent radiotherapy of 54-66 Gy(1.8-2.0 Gy×5 times per week)and those in group B were treated with cisplatin combined with fluorouracil(PF regime).The clinical efficacy and adverse responses were compared between two groups.Results The effectiveness rate and disease control rate of group A were higher than those of group B(65.0%vs.50.0%and 95.0%vs.90.0%)(P<0.05).The median progression-free survival time and overall survival time of group A were longer than those of group B(18 months vs.14 months and 31 months vs.25 months)(P<0.05).The 1-year and 2-year survival rates of group A were higher than those of group B(81.7% vs.76.7% and 58.3% vs.41.7%)(P<0.05).The incidence rates of degreeⅢ-Ⅳ nausea and vomiting were lower,but those of degreeⅠ-Ⅱ neurotoxicity and degreeⅢ-Ⅳ myelosuppression were higher,in group A than those in group B(P<0.05).Conclusion Compared to PF regime,the weekly dosage of TP regime combined with concurrent radiotherapy has better clinical efficacy in the treatment of the patients with locally advanced esophageal cancer who lost the chance of surgery.
引文
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[13]Enzinger PC,Ryan DP,Clark JW,et al.Weekly docetaxel,cisplatin and irinotecan(TPC):results of a multicenter phaseⅡtrial in patients with metastatic esophagogastric cancer[J].Ann Oncol,2009,20(3):475-480.
[14]姜兆祥,王忠超,李倩,等.TP方案及FP方案同步调强放疗治疗中晚期食管癌的临床疗效评价[J].黑龙江医药,2015,27(4):952-954.
[15]张歌萌,韩良辅,张双燕,等.多西他赛联合顺铂同步放化疗治疗局部晚期食管癌的疗效分析[J].中国医药科学,2012,2(22):14-15.
[16]赵骞,宁旭.TP方案同步放化疗对非手术局部晚期食管癌的疗效[J].贵州医科大学学报,2017,42(8):952-956.
[2]Nakamura K,Kato K,Igaki H,et al.Three-arm phaseⅢtrial comparing cisplatin plus 5-FU(CF)versus docetaxel,cisplatin plus 5-FU(DCF)versus radiotherapy with CF(CF-RT)as preoperative therapy for locally advanced esophageal cancer(JCOG1109,NExT study)[J].Jpn J Clin Oncol,2013,43(7):752-755.
[3]Eisenhauer EA,Therasse P,Bogaerts J,et al.New response evaluation criteria in solid tumours:revised RECIST guideline(version 1.1)[J].Eur J Cancer,2009,45(2):228-247.
[4]Cox JD,Stetz J,Pajak TF.Toxicity criteria of the radiation therapy oncology group(RTOG)and the European organization for research and treatment of cancer(EORTC)[J].Int JRadiat Oncol Biol Phys,1995,31(5):1341-1346.
[5]何少忠,孙新臣.食管癌同步放化疗临床研究进展[J].临床肿瘤学杂志,2008,13(2):179-182.
[6]Wong R,Malthaner R.Combined chemotherapy and radiotherapy(without surgery)compared with radiotherapy alone in localized carcinoma of the esophagus[J].Cochrane Database Syst Rev,2006,25(1):CD002092.
[7]陈志明,陈晓珏,薛强,等.奈达铂周剂量化疗同步放疗治疗老年食管癌的疗效[J].江苏医药,2015,41(20):2423-2425.
[8]Stahl M,Mariette C,Haustermans K,et al.Oesophageal cancer:ESMO clinical practice guidelines for diagnosis,treatment and follow-up[J].Ann Oncol,2013,24(Suppl 6):vi51-vi56.
[9]Stahl M,Budach W,Meyer HJ,et al.Esophageal cancer:clinical practice guidelines for diagnosis,treatment and follow-up[J].Ann Oncol,2010,21(Suppl 5):v46-v49.
[10]Muro K,Hamaguchi T,Ohtsu A,et al.A phaseⅡstudy of single-agent docetaxel in patients with metastatic esophageal cancer[J].Ann Oncol,2004,15(6):955-959.
[11]Huang TC,Hsu CH,Lin CC,et al.Systematic review and network meta-analysis:neoadjuvant chemoradiotherapy for locoregional esophageal cancer[J].Jpn J Clin Oncol,2015,45(11):1023-1028.
[12]Hu G,Wang Z,Wang Y,et al.Comparison of cisplatinum/paclitaxel with cisplatinum/5-fluorouracil as first-line therapy for nonsurgical locally advanced esophageal squamous cell carcinoma patients[J].Drug Des Devel Ther,2016,10:2129-2136.
[13]Enzinger PC,Ryan DP,Clark JW,et al.Weekly docetaxel,cisplatin and irinotecan(TPC):results of a multicenter phaseⅡtrial in patients with metastatic esophagogastric cancer[J].Ann Oncol,2009,20(3):475-480.
[14]姜兆祥,王忠超,李倩,等.TP方案及FP方案同步调强放疗治疗中晚期食管癌的临床疗效评价[J].黑龙江医药,2015,27(4):952-954.
[15]张歌萌,韩良辅,张双燕,等.多西他赛联合顺铂同步放化疗治疗局部晚期食管癌的疗效分析[J].中国医药科学,2012,2(22):14-15.
[16]赵骞,宁旭.TP方案同步放化疗对非手术局部晚期食管癌的疗效[J].贵州医科大学学报,2017,42(8):952-956.