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中华放射肿瘤学杂志
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中华放射肿瘤学杂志  2015, Vol. 24 Issue (2): 106-110    DOI: 10.3760/cma.j.issn.1004-4221.2015.02.000
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不能手术食管癌三维放疗与同期放化疗生存比较
谭立君,肖泽芬,张红星,陈东福,冯勤付,周宗玫,吕纪马,梁军,殷蔚伯
100021 北京协和医学院 中国医学科学院肿瘤医院肿瘤放疗科(谭立君工作单位哈尔滨医科大学附属第一医院肿瘤一科)
Survival comparison of three-dimensional radiotherapy alone with concurrent chemoradiotherapy for non-surgical esophageal carcinoma
Tan Lijun, Xiao Zefen, Zhang Hongxing, Chen Dongfu, Feng Qinfu, Zhou Zongmei, Lyu Jima, Liang Jun, Yin Weibo
Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Sciences,Peking Union Medical College, Beijing 100021,China
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摘要 目的 不能手术食管癌采用三维放疗技术单纯放疗(RT)与同期放化疗(CCRT)的生存比较。方法 搜集2002—2012年间本院行根治性3DRT和CCRT食管鳞癌480例患者资料,采用倾向配比评分法配对后共296例患者入组,分析比较两组患者生存情况。结果 3DRT和CCRT组3、5年样本数分别为58、48例和58、52例。3DRT和CCRT组3、5年OS分别为32.6%、22.1%和35.1%、26.5%(P=0.463);PFS分别为27.8%、19.8%和30.7%、25.8%(P=0.637)。60~70 Gy亚组3DRT和CCRT的5年OS相近(25.6%和25.3%,P=0.833)、PFS相近(22.7%和25.2%,P=0.999),血道转移率相近(23.4%和24.1%,P=0.899)。50.0~59.9 Gy亚组CCRT 的5年OS和PFS高于3DRT (32.3%∶12.0%,P=0.030和24.1%∶10.6%,P=0.087);3DRT组中60~70 Gy亚组5年OS和PFS明显好于50.0~59.9 Gy亚组(P=0.024和0.041);CCRT组中2个亚组的OS和PFS相近(P=0.791和0.984)。CCRT组不良反应大于3DRT组(主要为食管炎和白细胞下降,P=0.000、0.005),但患者均能耐受。结论 不能手术食管癌患者采用3D放疗技术根治性同期放化疗时建议适当降低放疗剂量, 不能同期放化疗患者给予60~70 Gy放疗也能获得较好生存,但仍需要随机研究的结果证实。
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谭立君
肖泽芬
张红星
陈东福
冯勤付
周宗玫
吕纪马
梁军
殷蔚伯
关键词 食管肿瘤/三维放射疗法食管肿瘤/同期放化疗法预后    
Abstract:Objective To compare the survival between three-dimensional radiotherapy (3DRT) alone and concurrent chemoradiotherapy (C+3DRT) for non-surgical esophageal carcinoma. Methods Four hundred and eighty patients with esophageal squamous cell carcinoma who were treated with definitive 3DRT or C+3DRT in our institution from 2002 to 2012 were collected and 296 out of them were equally divided into 3DRT group and C+3DRT group. Survival comparison between the two groups was made by propensity score matching method. Patients were mainly given paclitaxel and platinum weekly in C+3DRT. Results The numbers of samples at 3 and 5 years were 58 and 48 in the 3DRT group, and 58 and 52 in the C+3DRT group. The 3-and 5-year overall survival (OS) rates were 32.6% and 22.1% in the 3DRT group, and 35.1% and 26.5% in the C+3DRT group (P=0.463).The 3-and 5-year progression-free survival (PFS) rates were 27.8% and 19.8% in the 3DRT group, and 30.7% and 25.8% in the C+3DRT group (P=0.637). In the 3DRT and C+3DRT groups, patients treated with 60.0-70.0 Gy had similar OS rates (25.6% vs. 25.3%, P=0.833), PFS rates (22.7% vs. 25.2%, P=0.999), and incidence rates of hematogenous metastasis (23.4% vs. 24.1%, P=0.899) at 5 years. Patients treated with 50.0-59.9 Gy had significantly higher 5-year OS and PFS rates in the C+3DRT group than in the 3DRT group (32.3% vs. 12.0%,P=0.030;24.1% vs. 10.6%,P=0.087). In the 3DRT group, patients treated with 60.0-70.0 Gy had significantly higher 5-year OS and PFS rates than those treated with 50.0-59.9 Gy (P=0.024,P=0.041). In the C+3DRT group, patients treated with 60.0-70.0 Gy and 50.0-59.9 Gy had similar 5-year OS and PFS rates (P=0.791,P=0.984). The incidence rates of adverse reactions, such as esophagitis and leukopenia, in the C+3DRT group were significantly higher than those in the 3DRT group (P=0.000,P=0.005). However, those adverse reactions could be tolerated by patients. Conclusions For patients with non-surgical esophageal carcinoma, a low dose in definitive C+3DRT is recommended. 60-70 Gy in 3DRT alone can also achieve a promising survival in patients who cannot receive C+3DRT, which still needs to be confirmed by randomized studies.
Key wordsEsophageal neoplasms/three-dimensional radiotherapy    Esophageal neoplasms/concurrent chemoradiotherapy    Prognosis   
收稿日期: 2014-10-13     
基金资助:首都临床特色应用研究(Z121107001012004);北京希望马拉松专项基金(LC2012Z01);国家自然科学基金(81272512)
通讯作者: 肖泽芬,Email:xiaozefen@sina.com   
引用本文:   
谭立君,肖泽芬,张红星等. 不能手术食管癌三维放疗与同期放化疗生存比较[J]. 中华放射肿瘤学杂志, 2015, 24(2): 106-110.
Tan Lijun,Xiao Zefen,Zhang Hongxing et al. Survival comparison of three-dimensional radiotherapy alone with concurrent chemoradiotherapy for non-surgical esophageal carcinoma[J]. Chinese Journal of Radiation Oncology, 2015, 24(2): 106-110.
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