【摘要】：本研究試圖研究調(diào)強放療和三維適形放療兩種放療方法之間、順鉑聯(lián)合5-氟脲嘧啶與替加氟兩種化療方法之間，，治療食管癌（EC）的在近期療效和毒副反應(yīng)等方面的差異；同時通過替加氟同步調(diào)強放療治療局部中晚期食管癌，對其近期療效進(jìn)行觀察，對其不良反應(yīng)和患者的耐受性進(jìn)行研究，嘗試將其作為中晚期EC的綜合治療方案進(jìn)行臨床驗證，試驗結(jié)果良好。 先選取6例接受放療的患者，調(diào)強放療和三維適形放療各3例，分析比較其放射劑量的分布情況；選取2順鉑聯(lián)合5-氟脲嘧啶與替加氟化療患者各20名，比較兩組的近期療效和毒副方應(yīng)的差異；最后選取57例中晚期EC患者，分成單純手術(shù)治療組、單純放療組和替加氟化療同步調(diào)強放療組三個組進(jìn)行對比研究，收集臨床治療和隨訪觀察數(shù)據(jù)，比較近期療效、隨訪及一年生存率、放化療不良反應(yīng)監(jiān)測以及生存質(zhì)量改善指標(biāo)等數(shù)據(jù)在三組間的差別。 基于劑量分布、保護(hù)正常組織功能和靶區(qū)適形性等分析發(fā)現(xiàn)，IMRT比3D-CRT表現(xiàn)更為優(yōu)秀。替加氟比DDP及5-FU有較好的近期療效，未達(dá)到統(tǒng)計意義上的差異顯著性，但替加氟組的毒副反應(yīng)相比其它的組要輕。此外，在近期療效及一年生存率上，替加氟同步調(diào)強放療組優(yōu)于常規(guī)手術(shù)組和單純放療組，分別為90.0%和61.3%，而常規(guī)手術(shù)組為66.7%和41.2%，常規(guī)放療組為78.9%和46.8%，試驗結(jié)果體現(xiàn)了放化療協(xié)同效應(yīng)的優(yōu)越性。在不良反應(yīng)監(jiān)測上，替加氟同步調(diào)強放療與常規(guī)放療組對比無差異。而替加氟同步調(diào)強放療方法對患者近期生存質(zhì)量的改善比較明顯，在放射性食管炎、進(jìn)食情況、KPS生活質(zhì)量評分、血紅蛋白濃度上均優(yōu)于其他兩組。 本研究證明了替加氟同步調(diào)強放療在中晚期EC治療中有較好的近期療效和一年生存率，而且副反應(yīng)并未進(jìn)一步提高，可以為患者耐受，因此值得作為中晚期EC的一種新的治療手段進(jìn)一步嘗試。
[Abstract]:The purpose of this study was to study the difference between IMRT and 3D conformal radiotherapy, cisplatin combined with 5-fluorouracil and tegafur in the treatment of esophageal cancer (EC) in the short term and side effects. At the same time, through the treatment of local advanced esophageal carcinoma with Tegafur synchronous intensity modulated radiotherapy, the short-term curative effect was observed, and the adverse reactions and patient tolerance were studied. The test results are good. First, 6 patients received radiotherapy, 3 patients received intensity modulated radiotherapy (IMRT) and 3 patients were treated with three dimensional conformal radiotherapy (3D conformal radiotherapy), and the distribution of radiation dose was analyzed and compared. 20 patients with cisplatin combined with 5-fluorouracil and 20 patients with tigafur chemotherapy were selected to compare the short-term curative effect and the difference of toxicant prescription between the two groups. Finally, 57 patients with advanced EC were divided into three groups: simple operation group, radiotherapy group and tigafur chemotherapy combined with intensity modulated radiotherapy group. The clinical treatment and follow-up observation data were collected to compare the short-term curative effect. The data of follow-up and one-year survival rate, adverse reaction monitoring of radiotherapy and chemotherapy, and quality of life improvement were different among the three groups. Based on the analysis of dose distribution, protection of normal tissue function and target conformability, it was found that IMRT performed better than 3D-CRT. Tegafur had better short-term curative effect than DDP and 5-FU, but the toxicity of tigafur group was lighter than that of other groups. In addition, in terms of short-term curative effect and 1-year survival rate, tigafur synchronous intensity modulated radiotherapy group was superior to conventional surgery group and simple radiotherapy group (90.0% and 61.3%, respectively), while conventional operation group was 66.7% and 41.2%, respectively. The conventional radiotherapy group was 78.9% and 46.8% respectively. The results showed the superiority of the synergistic effect of radiotherapy and chemotherapy. In adverse reaction monitoring, there was no difference between Tegafur simultaneous intensity modulated radiotherapy group and conventional radiotherapy group. The quality of life of patients with radiation esophagitis, food intake, KPS quality of life score and hemoglobin concentration were better than those of other two groups in terms of radiation esophagitis, food intake, quality of life score and hemoglobin concentration. This study demonstrated that Tegafur synchronous intensity modulated radiotherapy has good short-term efficacy and 1-year survival rate in the treatment of intermediate and advanced EC, and the side effects have not been further improved and can be tolerated by patients. Therefore, it is worthy of further attempt as a new treatment for EC in middle and late stage.
【學(xué)位授予單位】：清華大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R735.1;R730.55

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