后程加速超分割放射辅以顺铂增敏治疗食管癌临床研究
Clinical Study of Later Course Accelerated Hyperfractionation Radiotherapy Adjuvant with Cisplatin in Treatment of Esophageal Carcinoma
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摘要: 目的 探讨后程加速超分割 (下简称后超 )加顺铂治疗食管癌的疗效及对免疫功能的影响。方法 将符合入选条件的 10 4例食管鳞癌患者随机分为A、B两组。A组为后超 +顺铂组 5 1例 ;B组为单纯后程加速超分割放疗组 5 3例。两组放疗方法相同 :前 3周为常规放疗, 后 2周加速超分割放疗, 总量至第 5周 6 0Gy。A组在放疗第 1、5两周加用顺铂。同时观察外周淋巴细胞CD4、CD8、CD5 6抗原的阳性率。结果 2年生存率分别为 4 7.2 %和 30 .2 %, P <0 .0 5。治疗后CD4 /CD8比值较治疗前明显下降 ;CD5 6阳性率则升高。副反应A组较B组更重 (P <0 .0 1), 进食疼痛和恶心呕吐均无显著性差异 (P>0 .0 5 )。结论 (1)后超同时在第 1周和第 5周给予小剂量顺铂比单纯后超改善了 2年生存率, 但加重了骨髓毒性。 (2 )后超放疗加顺铂可能使食管癌病人的细胞免疫水平降低, 体液免疫水平提高。 (3)化疗与后超放疗相结合治疗食管癌, 病人可以耐受, 方案需要进一步探索。Abstract: Objective To evaluate the value of later course accelerated hyperfractionation radiotherapy (LCAHR) adjuvant with cisplatin in treatment of esophageal carcinoma and the effect on the immune state of the patients. Methods 104 cases of squamous cell carcinoma of esophagus were randomized into group A (53 patients) and group B (51 patients). Group A received a dose of 30Gy with conventional fractionation in first 3 weeks and 30Gy with 1.5Gy/f, twice per day in later 2 weeks. A total dose is 60Gy/35f/5 weeks....
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