CAJ | 학술논문

目的比较后程加速超分割适形放疗联合卡培他滨与单纯后程加速超分割适形放疗及常规放疗治疗食管癌的疗效，探讨卡培他滨的放疗增敏作用。方法 168例食管鳞癌患者随机分为3组，即常规放疗(CF)组（50例，2.0 Gy/次，5次/周，总量60～66 Gy）、后程加速超分割适形放疗(LCAF)组（55例，常规适形照射至40 Gy后改为2次/d，1.3Gy/次，间隔6h，总量64 ～69 Gy）和后程加速超分割适形放疗联合卡培他滨(LCAF+C)组（63例，照射方法与LCAF组相同，放疗开始后口服卡培他滨至放疗结束），比较3组患者的近期疗效、生存率、放疗毒副反应和并发症等。结果 CF组、LCAF组和LCAF+C组患者的有效率分别为74.0％、85.5％和95.2％，差异有统计学意义(P＝0.006)。CF组患者的1、3和5年局部控制率分别为64.0％、30.0％和24.0％，LCAF组患者的1、3和5年局部控制率分别为81.8％、65.5％和58.2％，LCAF+C组患者的1、3和5年局部控制率分别为90.1％、77.8％和74.6％。CF组患者的1、3和5年生存率分别为58.0％、20.0％和8.0％，LCAF组患者的1、3和5年生存率分别为78.2％、36.4％和17.0％，LCAF+C组患者的1、3和5年生存率分别为85.7％、55.6％和30.2％；LCAF组和LCAF+C组患者的1、3和5年生存率均明显高于CF组（P值分别为0.024、0.001和0.007）。LCAF+C组患者的5年局部控制率和5年生存率均明显高于LCAF组（P值分别为0.042和0.046）。LCAF+C组和LCAF组急性放疗反应和并发症的发生率高于CF组，但放射性肺炎的发生率以及死于肿瘤未控或复发的比率低于CF组（均P＜0.05）。结论卡培他滨对食管癌放疗有增敏作用，它与后程加速超分割适形放疗结合能提高食管癌患者的局部控制率和生存率。
목적 비교후정가속초분할괄형방료연합잡배타빈여단순후정가속초분할괄형방료급상규방료치료식관암적료효，탐토잡배타빈적방료증민작용。방법 168례식관린암환자수궤분위3조，즉상규방료(CF)조（50례，2.0 Gy/차，5차/주，총량60～66 Gy）、후정가속초분할괄형방료(LCAF)조（55례，상규괄형조사지40 Gy후개위2차/d，1.3Gy/차，간격6h，총량64 ～69 Gy）화후정가속초분할괄형방료연합잡배타빈(LCAF+C)조（63례，조사방법여LCAF조상동，방료개시후구복잡배타빈지방료결속），비교3조환자적근기료효、생존솔、방료독부반응화병발증등。결과 CF조、LCAF조화LCAF+C조환자적유효솔분별위74.0％、85.5％화95.2％，차이유통계학의의(P＝0.006)。CF조환자적1、3화5년국부공제솔분별위64.0％、30.0％화24.0％，LCAF조환자적1、3화5년국부공제솔분별위81.8％、65.5％화58.2％，LCAF+C조환자적1、3화5년국부공제솔분별위90.1％、77.8％화74.6％。CF조환자적1、3화5년생존솔분별위58.0％、20.0％화8.0％，LCAF조환자적1、3화5년생존솔분별위78.2％、36.4％화17.0％，LCAF+C조환자적1、3화5년생존솔분별위85.7％、55.6％화30.2％；LCAF조화LCAF+C조환자적1、3화5년생존솔균명현고우CF조（P치분별위0.024、0.001화0.007）。LCAF+C조환자적5년국부공제솔화5년생존솔균명현고우LCAF조（P치분별위0.042화0.046）。LCAF+C조화LCAF조급성방료반응화병발증적발생솔고우CF조，단방사성폐염적발생솔이급사우종류미공혹복발적비솔저우CF조（균P＜0.05）。결론 잡배타빈대식관암방료유증민작용，타여후정가속초분할괄형방료결합능제고식관암환자적국부공제솔화생존솔。
Objective To evaluate the efficacy of late accelerated hyperfractionated conformal radiotherapy (LACF) combined with capecitabine on esophageal carcinoma. Methods One hundred and sixty eight patients of esophageal cancer were randomly divided into 3 groups, including the radiotherapy alone group (CF) which received conventional conformal radiotherapy to a total of 60-66 Gy, LCAF group which received conventional fractionated conformal radiotherapy during the first two-thirds of the treatment to a dose about 40 Gy/20F/4W, then followed by late accelerated hyperfractionated conformal radiotherapy,twice daily radiotherapy at 1.3 Gy per fraction to a total dose about 64-69 Gy, and LCAF + C group (late accelerated hyperfractionated radiotherapy combined with capecitabine), in which patients were treated as the same as the LCAF group, except that they were treated with capecitabine ( 1.5 g po bid) from beginning of the radiotherapy to the end. Results The short-term results of the 3 groups were 74.0％, 85.5％ and 95.2％, respectively(P ＝ 0. 006). The local control rates at 1, 3 and 5 years were 64.0％, 30.0％,24.0％ in the CF group, 81.8％, 65.5％, 58.2％ in the LCAF group and 90.1％, 77.8％, 74.6％ in the LCAF + C group, respectively. The 1-, 3-and 5-year survival rates of the 3 groups were 58.0％,20.0％, 8.0％ ; 78.2％, 36.4％, 17.0％ and 85.7％, 55.6％, 30.2％, respectively. The effect of LCAF + C group was better than that of LCAF group and CF group. The incidence of acute tracheitis and acute esophagitis in the LCAF + C group and LCAF group was higher than that in the CF group, but there was no stastistically significant difference between the 2 groups. There was no statistically significant difference in distant metastasis in the 3 groups. ConclusionsCapecitabine, as an effective chemosensitizater combined with late accelerate hyperfractionated radiotherapy can improve the short-term results of treatment of esophageal cancer. The value of this combined treatment in distant metastasis reqires further study in the clinic.