CAJ | 학술논문

目的比较局部进展期食管鳞癌不同新辅助放化疗方案的近期疗效.方法随机将154例局部进展期食管鳞癌患者分为实验组(多西他赛+顺铂化疗)和对照组(顺铂+氟尿嘧啶化疗),进行2个周期的化疗和40 Gy的纵隔放疗,3～4周后手术治疗.以同期直接手术的237例食管鳞癌患者(单纯手术组)为参照,比较近期疗效.结果全部患者均完成新辅助放化疗,其中9例因肿瘤进展放弃手术治疗.实验组和对照组总的3～4级不良反应发生率分别为53.2％和36.4％ (x2=4.44,P=0.035),其中粒细胞减少的发生率分别为20.7％和5.2％ (x2=8.28,P=0.004).实验组手术切除率为92.2％ (71/77),完全性切除率为89.6％(69/77)；对照组手术切除率为90.9％(70/77),完全性切除率为85.7％(66/77)；实验组和对照组的手术切除率和完全性切除率比较,差异均无统计学意义(P =0.77,P=0.46).实验组和对照组的并发症发生率分别为21.9％(16/73)和23.6％(17/72),差异无统计学意义(x2 =0.059,P=0.81).实验组和对照组新辅助放化疗后的病理完全缓解(pCR)率分别35.1％(27/77)和20.8％ (16/77),差异有统计学意义(x2=3.90,P=0.048).结论与传统的顺铂+氟尿嘧啶方案比较,多西他赛+顺铂方案联合常规分割放疗可以获得更高的pCR.
목적 비교국부진전기식관린암불동신보조방화료방안적근기료효.방법 수궤장154례국부진전기식관린암환자분위실험조(다서타새+순박화료)화대조조(순박+불뇨밀정화료),진행2개주기적화료화40 Gy적종격방료,3～4주후수술치료.이동기직접수술적237례식관린암환자(단순수술조)위삼조,비교근기료효.결과 전부환자균완성신보조방화료,기중9례인종류진전방기수술치료.실험조화대조조총적3～4급불량반응발생솔분별위53.2％화36.4％ (x2=4.44,P=0.035),기중립세포감소적발생솔분별위20.7％화5.2％ (x2=8.28,P=0.004).실험조수술절제솔위92.2％ (71/77),완전성절제솔위89.6％(69/77)；대조조수술절제솔위90.9％(70/77),완전성절제솔위85.7％(66/77)；실험조화대조조적수술절제솔화완전성절제솔비교,차이균무통계학의의(P =0.77,P=0.46).실험조화대조조적병발증발생솔분별위21.9％(16/73)화23.6％(17/72),차이무통계학의의(x2 =0.059,P=0.81).실험조화대조조신보조방화료후적병리완전완해(pCR)솔분별35.1％(27/77)화20.8％ (16/77),차이유통계학의의(x2=3.90,P=0.048).결론 여전통적순박+불뇨밀정방안비교,다서타새+순박방안연합상규분할방료가이획득경고적pCR.
Objective To compare the efficacy and feasibility of neoadjuvant chemoradiotherapy with docetaxel plus cisplatin or with cisplatin plus fluorouracil in the treatment of local advanced esophageal squamous cell carcinoma.Methods A total of 154 cases in the stage of cT3N0-1M0 were randomly assigned to two arms.The arm A received 2 cycles of doctaxel 75 mg/m2 plus cisplatin 25 mg/m2 d1-3 and 40 Gy of radiation therapy,and the arm B received 2 cycles of cisplatin 25 mg/m2 d1-3 plus fluorouracil 600 mg/m2 d1 ～ 5 and 40 Gy of radiation therapy.The surgery was performed 3-4 weeks later.Results Grade 3/4 toxicities occurred in 53.2％ of the patients in arm A and in 36.4％ of the patients in arm B (P =0.035).Neutropenia occurred in 20.7％ of the patients in arm A and 5.6％ of the patients in arm B(P =0.004).Nine patients aborted surgery due to tumor progression.71 patients underwent resection in 73 cases of the arm A and 69 patients underwent complete resection,70 patients underwent resection in 72 cases and 70 complete resection of the arm B,respectively (P ＞0.05).No mortality was noted.The overall complication rate was similar in the two arms (21.9％ vs.23.6％).Pathological complete response was achieved in 27 patients (35.1％) in the arm A and 16 patients (20.8％) in the arm B (P =0.048).Conclusions Neoadjuvant chemoradiotherapy with docetaxel plus cisplatin can be well tolerated and achieves a higher pathological complete response rate than with cisplatin plus fluorouracil.