本文選題：調(diào)強(qiáng)放療　切入點(diǎn)：三維適形放療　出處：《河南大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：研究目的:我院開展三維適形放療聯(lián)合化療治療食管癌10余年,取得了較好的臨床效果,積累了豐富臨床經(jīng)驗(yàn),但調(diào)強(qiáng)放療聯(lián)合紫杉醇及奈達(dá)鉑化療治療食管癌的臨床療效尚未見報(bào)告,本研究搜集我院80例食管癌患者,旨在分析食管癌患者接受調(diào)強(qiáng)放療與三維適形放療聯(lián)合紫杉醇及奈達(dá)鉑同步化療的近期療效及耐受性。研究方法:本研究通過收集2012年9月至2014年12月于河南大學(xué)第一附屬醫(yī)院就診80例食管癌患者,病理為食管鱗狀細(xì)胞癌,無(wú)放化療禁忌癥,且不能手術(shù)或不愿手術(shù),分期按UICC食管癌國(guó)際分期原則,沒有穿孔前表現(xiàn)(包括龕影、癌性潰瘍、彎曲成角畸形),心、肝、腎功能無(wú)明顯異常,骨髓狀況正常,無(wú)重大內(nèi)科疾患,KPS≥70分;相關(guān)檢查提示病變局限食管;評(píng)估生存時(shí)間不少于半年,隨機(jī)分為IMRT聯(lián)合紫杉醇及奈達(dá)鉑方案放化療組(實(shí)驗(yàn)組)和3D-CRT聯(lián)合紫杉醇及奈達(dá)鉑方案放化療組(對(duì)照組),每組40例,兩組被試的一般情況比較結(jié)果顯示,無(wú)明顯統(tǒng)計(jì)學(xué)差異(P0.05);放療方面:處方劑量為95%的PTV,每周放療5次,總劑量64 Gy/32f/6.4周。重要臟器劑量保護(hù):肺V2030%,V3020%,脊髓最大劑量(Dmax)45Gy;化療方面:生理鹽水250ml中配置奈達(dá)鉑40mg/m2靜脈輸液,第1,8天;生理鹽水500ml中配置紫杉醇80mg/m2靜脈輸液,用藥前12h、6h各口服地塞米松片7.5mg,應(yīng)用苯海拉明20mg肌注,生理鹽水250ml中配置雷尼替丁100mg靜脈輸液預(yù)防變態(tài)反應(yīng)在用藥前30分鐘給予,第1,8天,放療第一天開始化療,以上方案每4周重復(fù)1次,化療3-4周期,定期復(fù)查肝腎功能,若有肝功能增高癥狀,可口服保肝藥物或者靜脈輸液;若有腎功能增高,應(yīng)用改善腎臟微循環(huán)藥物輸液治療,密切觀察骨髓情況。放化療盡可能同步進(jìn)行。常規(guī)采用多功能監(jiān)護(hù)儀監(jiān)測(cè)生命體征變化。比較兩種治療方法,研究調(diào)強(qiáng)放療對(duì)比三維適形放療聯(lián)合紫杉醇及奈達(dá)鉑方案同步化療的近期療效及耐受性。研究結(jié)果:80例患者全部按計(jì)劃完成治療,其中有3例患者因III度骨髓抑制使治療時(shí)間延長(zhǎng)1周。療效:全部治療結(jié)束后1月,評(píng)判療效主要依據(jù)治療前后胸部CT,X線鋇餐片的改變。根據(jù)WHO腫瘤近期療效標(biāo)準(zhǔn)評(píng)價(jià),分為CR、PR、SD、PD,近期有效率以CR+PR計(jì)算。實(shí)驗(yàn)組有效率(CR+PR)為90.0%(36/40)高于對(duì)照組的80.0%(32/40),兩組差異不顯著(χ2=1.569,P0.05);毒副反應(yīng):放療方面,以美國(guó)腫瘤放射治療協(xié)作組早期放射反應(yīng)依據(jù)評(píng)判;化療方面,毒副反應(yīng)按世界衛(wèi)生組織制定的抗腫瘤藥物急性與亞急性毒性反應(yīng)分級(jí)標(biāo)準(zhǔn)評(píng)定。兩組毒副反應(yīng)均以急性放射性食管炎、白細(xì)胞減少及血小板減少為主。兩組急性放射性食管炎按RTOG標(biāo)準(zhǔn)多為1,2級(jí),并且兩組無(wú)明顯差別,無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。患者對(duì)放化療引起的毒副反應(yīng)經(jīng)積極對(duì)癥治療后都能承受,都完成治療。我們?cè)谠O(shè)計(jì)實(shí)驗(yàn)時(shí)應(yīng)用的化療藥物劑量適中,并非較大劑量,并且及時(shí)予以對(duì)癥及營(yíng)養(yǎng)支持治療,所以化療引起的副反應(yīng)是能夠承受的,以確保整個(gè)治療的完整性和連續(xù)性,實(shí)驗(yàn)組在肺V20、V30方面對(duì)比對(duì)照組有優(yōu)勢(shì)(P0.05),并且實(shí)驗(yàn)組的急性放射性肺炎發(fā)生率下降(P0.05)。結(jié)論:1,本研究采用調(diào)強(qiáng)放療或三維適形放療,化療手段為奈達(dá)鉑及紫杉醇方案。在增強(qiáng)腫瘤劑量的均勻性,加大腫瘤劑量方面調(diào)強(qiáng)放療似乎更佳,而且還能減少腫瘤周圍重要臟器的劑量,近期治療效果佳;2,研究數(shù)據(jù)提示實(shí)驗(yàn)組的V20,V30顯著優(yōu)于對(duì)照組,實(shí)驗(yàn)組的放射性肺炎發(fā)生率下降。3,目前局部中晚期不能手術(shù)的食管癌應(yīng)用同步放化療是標(biāo)準(zhǔn)治療手段,同步放化療治療食管癌既有明顯的相互增敏作用,兩種治療協(xié)同起效,增加了近期治療效果及生活質(zhì)量。
[Abstract]:Objective: Our Hospital of three-dimensional conformal radiotherapy combined with chemotherapy in the treatment of esophageal cancer for more than 10 years, has better clinical effect, has accumulated rich clinical experience, but the clinical efficacy of intensity-modulated radiotherapy combined with paclitaxel and nedaplatin in the treatment of esophageal cancer has not been reported, this study collected in our hospital 80 cases of patients with esophageal cancer. Aimed at the analysis of patients with esophageal carcinoma underwent IMRT with three-dimensional conformal radiotherapy combined with paclitaxel and nedaplatin chemotherapy efficacy and tolerability. Methods: in this study, the First Affiliated Hospital of Henan University in 80 cases of esophageal cancer patients by collecting from September 2012 to December 2014, the pathology of esophageal squamous cell carcinoma, and no chemotherapy contraindications. No surgery or refused operation, according to the UICC staging of esophageal cancer staging international principle, no perforation before the performance (including niche, cancerous ulcer, bending deformity), heart, liver, renal function was not significantly different Often, the bone marrow condition is normal, no major diseases, KPS = 70; related examination showed localized lesions of esophageal; evaluate the survival time of less than half a year, were randomly divided into IMRT combined with paclitaxel and nedaplatin chemotherapy group (experimental group) and 3D-CRT combined with paclitaxel and nedaplatin program chemotherapy group (control group), 40 cases in each group. The general situation of the two groups of subjects comparison showed that no statistically significant difference (P0.05); radiotherapy: the prescription dose was 95% PTV, 5 times a week of radiotherapy, total dose of 64 Gy/32f/6.4 weeks. The dose of important organs: lung protection V2030%, V3020%, maximum dose of spinal cord (Dmax) 45Gy chemotherapy; nedaplatin: intravenous infusion of saline 250ml 40mg/m2 configuration, the first 1,8 days; paclitaxel intravenous infusion of saline 500ml 80mg/m2 configuration, 12h 6h before treatment, the oral administration of Dexamethasone Tablets 7.5mg, application of Hella Ming 20mg intramuscular injection, Rene saline 250ml configuration Cimetidine 100mg intravenous infusion to prevent allergy medication in 30 minutes before, the first 1,8 days, the first day of radiotherapy chemotherapy, the above scheme was repeated every 4 weeks for 1 times, 3-4 cycles of chemotherapy, liver and kidney function regularly, if liver function increased symptoms, oral or intravenous infusion of hepatoprotective drugs; if renal function increased application of improved renal microcirculation, drug infusion therapy, close observation of bone marrow. Chemotherapy as much as possible simultaneously. By using conventional monitoring of vital signs multi function. Comparison of two kinds of treatment methods of IMRT compared with three-dimensional conformal radiotherapy combined with paclitaxel and nedaplatin chemotherapy efficacy and tolerability study. Results: all 80 patients completed the treatment as planned, including 3 patients with III myelosuppression that prolonged treatment for 1 weeks. The curative effect: after all the treatment in January, mainly based on the evaluation of the curative effect before treatment After the chest CT, X-ray barium X-ray changes. According to a recent WHO tumor evaluation standard of curative effect, divided into CR, PR, SD, PD, the short-term effective rate was calculated with the CR+PR. The effective rate of experimental group (CR+PR) 90% (36/40) higher than 80% in the control group (32/40), the two groups had no significant difference (x2 2=1.569, P0.05); toxicity of radiotherapy, the Radiation Therapy Oncology Group on the basis of early radiation response evaluation; chemotherapy, acute and subacute toxicity toxicity by WHO to develop anticancer drug classification criteria. The toxicity of the two groups were with acute radiation esophagitis, leukopenia and platelet decreased. Two groups of acute radiation esophagitis according to the standard of RTOG for 1,2, and the two group had no significant difference, no statistical significance (P0.05). The adverse reaction caused by chemotherapy of patients after symptomatic treatment can take complete treatment. We set up in The application of moderate dose chemotherapy meter experiment, not large dose, and timely symptomatic and supportive therapy, so the side effects caused by chemotherapy is able to bear, in order to ensure the integrity and continuity of the treatment, the experimental group in the lung V20, V30 compared with the advantage of control group (P0.05), and the experimental group decreased the incidence of acute radiation pneumonitis (P0.05). Conclusion: 1. This study uses intensity-modulated radiotherapy and three-dimensional conformal radiotherapy, chemotherapy for nedaplatin and paclitaxel. In enhancing the uniformity of tumor dose, increase the tumor dose on intensity-modulated radiotherapy seems to be better, but also reduce the visceral tumors the dosage, therapeutic effect is good; 2, the research data showed that the experimental group V20, V30 was significantly better than the control group, the incidence of radiation pneumonitis in experimental group decreased by.3, the application of synchronous esophageal cancer in locally advanced inoperable Chemoradiotherapy is a standard treatment. Concurrent chemoradiotherapy has obvious sensitizing effects on esophageal cancer. The two treatments synergy and increase the short-term therapeutic effect and quality of life.

【學(xué)位授予單位】：河南大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R735.1

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