不同同步放化疗方案治疗局部晚期食管鳞癌临床对比研究

李道生

[摘要] 目的 探討奈达铂单药与奈达铂+替吉奥（S-1）分别同步联合精确放疗对局部晚期食管鳞癌患者临床疗效、生存率及毒副作用的影响。 方法 研究对象选取我院2014年6月～2017年6月收治的局部晚期食管鳞癌患者共80例，以随机抽签法分为对照组（40例）和观察组（40例），分别在精确放疗基础上给予奈达铂单用和奈达铂联合S-1同步治疗;比较两组患者客观缓解率、临床获益率、中位无进展生存时间、中位总生存时间、随访生存率、治疗后Karnofsky评分（KPS）改善效果及毒副作用发生率。 结果 观察组患者客观缓解率、临床获益率、中位无进展生存时间、中位总生存时间均、随访1年和2年生存率及KPS评分改善效果均显著优于对照组（P<0.05）;观察组患者Ⅰ～Ⅱ度WBC计数减少和食欲不振发生率均显著高于对照组（P<0.05）。 结论 奈达铂+S-1同步联合精确放疗治疗局部晚期食管鳞癌可有效控制病情进展，提高远期生存率，改善日常生活质量，且未诱发严重毒副作用，价值优于奈达铂单用。

[关键词] 铂类;替吉奥;局部晚期食管癌;疗效;安全性

[中图分类号] R735.1          [文献标识码] B          [文章编号] 1673-9701（2020）15-0101-04

Study on the clinical comparison of different concurrent chemoradiotherapy regimens in the treatment of locally advanced esophageal squamous carcinoma

LI Daosheng

Department of Oncology， Jiujiang First Peoples Hospital in Jiangxi Province， Jiujiang   332000， China

[Abstract] Objective To explore the effects of nedaplatin monotherapy and nedaplatin+tegafur（S-1） combined with concurrent precise radiotherapy on clinical efficacy， survival rate and toxic side effects of patients with locally advanced esophageal squamous carcinoma. Methods 80 patients with locally advanced esophageal squamous carcinoma who were admitted and treated in our hospital from June 2014 to June 2017 were selected as study subjects. They were randomly divided into control group（40 cases） and observation group（40 cases） based on random lot drawing method. On the basis of precise radiotherapy， nedaplatin monotherapy and nedaplatin combined with S-1 concurrent treatment were given. Objective remission rate， clinical benefit rate， median progression-free survival time， median total survival time， follow-up survival rate， Karnofsky score（KPS） improvement effect after treatment and incidence of toxic and side effects were compared between the two groups of patients. Results The objective remission rate， clinical benefit rate， median progression-free survival time， median total survival time， 1-year and 2-year follow-up survival rate， and KPS score improvement were significantly better in the observation group than in the control group（P<0.05）; decrease in Ⅰ-Ⅱ degree WBC count and the incidence of loss of appetite in the patients in the observation group were significantly higher than those in the control group（P<0.05）. Conclusion Nedaplatin+S-1 combined concurrent precise radiotherapy in the treatment of locally advanced esophageal squamous carcinoma can effectively control the disease progression， improve long-term survival rate， and improve the quality of daily life. It does not induce serious toxic and side effects， and its value is superior to that of nedaplatin alone.

[Key words] Platinum; Tegafur; Locally advanced esophageal squamous carcinoma; Efficacy; Safety

流行病学报道显示，全球每年新发食管癌患者约为45～50万，其中鳞癌所占比例超过90%[1]。食管癌患者早期症状隐匿，误诊漏诊较高，70%以上患者首次确诊时即已进入中晚期，难以实现根治切除[2]。对于无法或拒绝行手术治疗局部晚期食管癌患者采用单纯放疗方案后随访5年生存率不足12%;欧美诊疗指南推荐将同步放化疗作为局部晚期食管癌首选方案，部分临床报道显示总体疗效可接近根治手术;但以往采用铂类单药后病情控制效果不佳，约20%～40%患者可在1年内复发或转移[3，4]，近年来S-1开始被逐渐用于局部晚期食管癌辅助治疗，并取得令人满意效果，但其与铂类联用能否增加患者临床受益尚无明确定论。……