榄香烯乳联合顺铂同步放化疗后PF巩固化疗治疗中晚期食管癌

顾本兴; 胡建斌; 刘海; 孙晓南; 朱艳虹

doi:10.3969/j.issn.1000-8179.2013.10.012

榄香烯乳联合顺铂同步放化疗后PF巩固化疗治疗中晚期食管癌

Effect of the combination of Elemene and concurrent chemoradiation with cisplatin followed by consolidation chemotherapy with cisplatin and fluorouracil for locally advanced esophageal cancer

摘要

摘要:
目的探讨榄香烯乳联合顺铂同步放化疗后顺铂+5-Fu（PF）巩固化疗治疗中晚期食管癌的临床疗效。
方法榄香烯联合顺铂同步放化疗后PF巩固化疗治疗64例中晚期食管癌: 放疗采用三维适形放疗, 常规分割, 靶区总剂量55.8~66.6 Gy; 放疗同时给予顺铂（30 mg/m²第1~3天, 21天为一周期）化疗2周期。同步放化疗结束后给予不多于4周期PF方案（顺铂30 mg/m²第1~3天, 5-Fu500 mg/m²第1~5天）巩固化疗。其中联合组34例放疗期间应用榄香烯乳500 mg, 每日1次, 每周5次, 巩固化疗期间第1~5天给予榄香烯乳500 mg, 与同期接受顺铂同步放化疗后PF巩固化疗的30例中晚期食管癌患者进行对照。
结果 1）对照组和联合组有效率分别为63.3%和85.2%, 差异有统计学意义（P < 0.05）。2）对照组1、2年局部控制率分别为56.7%和33.8%, 联合组分别为69.9%和44.7%, 联合组有改善局部控制率的趋势（P=0.133）; 对照组1、2年生存率分别为60.0%和34.6%, 中位生存时间为13个月, 联合组1、2年生存率分别为64.7%和42.6%, 中位生存时间为15个月, Log-rank检验差异无统计学意义（P>0.05）。3）对照组Ⅲ、Ⅳ级白细胞下降的发生率为30%, 明显高于联合组的8.8%（P < 0.05）, Ⅲ、Ⅳ级血小板下降、胃肠道反应、放射性食管炎、放射性气管炎等急性不良反应两组差异有无统计学意义（P < 0.05）。
结论顺铂同步放化疗后PF巩固化疗治疗中晚期食管癌具有一定的疗效。榄香烯乳联合放化疗有助于提高近期疗效, 减轻血液学毒性, 值得进一步研究。

Abstract:
Objective The present study aimed to investigate the effect of the combination of Elemene and concurrent chemoradiation with cisplatin followed by consolidation chemotherapy with cisplatin and fluorouracil (PF) for locally advanced esophageal cancer.
Methods Sixty-four patients with locally advanced esophageal cancer were treated by using concurrent chemoradiation with cisplatin followed by PF consolidation chemotherapy. Concurrent chemoradiation consisted of three-dimensional conformal radiation at a total dose of 55.8 Gy to 66.6 Gy and two 21-d cycles of concurrent chemotherapy with 30 mg/m² cisplatin from days 1 to 3. Concurrent chemoradiation was followed by no more than four cycles of consolidation chemotherapy with 30 mg/m² cisplatin from days 1 to 3 and 500 mg/m² fluorouracil from days 1 to 5. For 34 cases in the union group, 500 mg/d Elemene was given during radiation and consolidation chemotherapy.
Results The overall response rates of the control group and the union group were 63.3% and 85.2% (P < 0.05), respectively. The one- and two-year local control rates of the control group were 56.7% and 33.8%, respectively, whereas those of the union group were 69.9% and 44.7%, respectively. The union group showed an increasing improvement trend on the one- and two-year local control rates (P=0.133). The one- and two-year overall survival rates in the control group were 60.0% and 34.6%, respectively, with median survival time of 13 months, whereas those in the study group were 64.7% and 42.6%, respectively, with median survival time of 15 months (P>0.05). The incidence of grade 3 or grade 4 leukocytopenia in the control group was significantly higher than that in the union group (30% versus 8.8%, P < 0.05). Incidences of thrombocytopenia, gastrointestinal reaction, acute radiation esophagitis, and radiation bronchitis were similar in both groups.
Conclusion Concurrent chemoradiation with cisplatin followed by consolidation chemotherapy with PF regimen is effective for locally advanced esophageal cancer. The combination of Elemene and chemoradiation for locally advanced esophageal cancer can improve response rate and reduce hematologic toxicity, which merits further study.

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