本文選題：食管腫瘤　切入點(diǎn)：術(shù)前同步放化療　出處：《西南醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:評估術(shù)前大分割放療與常規(guī)分割放療同步化療治療局部晚期食管鱗癌的療效和安全性,探討術(shù)前新輔助放療的放療分割模式。方法:2002年10月至2011年4月四川省腫瘤醫(yī)院收治食管癌患者中,有86例符合本次研究入排條件的局部晚期食管鱗癌患者,其中術(shù)前大分割放療組(A組)41例,30Gy/10次/2周,常規(guī)分割放療組(B組)45例,40Gy/20次/4周,化療方案均使用5-氟尿嘧啶300mg/m2靜脈滴注d1-3,順鉑30mg/m2靜脈滴注d1-3,21至28天為1個周期,共完成兩周期,放化療同步進(jìn)行,放化療結(jié)束后3-4周進(jìn)行手術(shù)治療。手術(shù)方式:對于食管胸上段癌常規(guī)從頸部、右胸以及上腹部做切口,行食管和胃頸部吻合,并對二野的淋巴結(jié)進(jìn)行清掃。對于食管胸中下段癌則從右胸和上腹部做切口,行食管和胃胸頂部器械吻合,對二野的淋巴結(jié)進(jìn)行清掃。兩組臨床資料采用χ2檢驗(yàn),生存分析的比較應(yīng)用kaplan-Meier法,Cox回歸模型進(jìn)行多因素分析。所有的統(tǒng)計(jì)檢驗(yàn)均應(yīng)用雙側(cè)檢驗(yàn),檢驗(yàn)效能0.8,P0.05為差異有統(tǒng)計(jì)學(xué)意義。主要研究終點(diǎn)為患者的降期情況、R0切除率、p CR率、生存率。次要研究終點(diǎn)為治療相關(guān)的不良反應(yīng)。結(jié)果:A組與B組降期率68.3%和55.6%(P=0.03),R0切除率分別為95.1和88.9%(P=0.02),p CR率分別為31.7%和24.4%(P=0.027),差異有統(tǒng)計(jì)學(xué)意義。大分割放療組和常規(guī)放療組1,2,3,4和5年OS分別為78.1%和68.9%,56.1%和48.9%,43.9%和44.4%,31.7%和35.6%,19.5%和15.6%,均無統(tǒng)計(jì)學(xué)差異(P0.05)。兩組患者放射性食管炎、放射性肺炎、白細(xì)胞減少、吻合瘺及傷口延期愈合率無明顯差異(P0.05)。術(shù)前大分割放化療在降期率、R0切除率、p CR率上較術(shù)前常規(guī)分割放化療組有優(yōu)勢(P0.05),兩組患者的總生存率及治療中副反應(yīng)發(fā)生率無統(tǒng)計(jì)學(xué)差異。單因素分析提示,放療前分期、體力狀態(tài)評分、腫瘤長度、放療后是否降期以及放療后是否達(dá)到病理緩解是影響患者生存的預(yù)后因素。多因素分析提示放療前分期、體力狀態(tài)評分、放療后是否降期以及放療后是否達(dá)到病理緩解是影響患者預(yù)后的獨(dú)立因素。結(jié)論:術(shù)前大分割放療相對于常規(guī)放療有更好的降期率、R0切除率和p CR率,但兩組患者的生存率無差異。術(shù)前大分割放療并不增加患者治療相關(guān)的放射性食管炎、放射性肺炎、白細(xì)胞減少、吻合瘺以及傷口延期愈合的發(fā)生率,且其治療周期短、并可以縮短患者住院時間,節(jié)約住院費(fèi)用,更容易為患者所接受。放療前分期早、放療后降期和放療后達(dá)到病理緩解的患者預(yù)后更優(yōu)。目前術(shù)前大分割放療及常規(guī)分割放療均可作為局部晚期食管癌術(shù)前放療的分割模式選擇方案,臨床中應(yīng)根據(jù)患者病情個體化決定具體治療方式。
[Abstract]:Objective: to evaluate the efficacy and safety of preoperative high-fractionation radiotherapy and conventional fractionated radiotherapy in the treatment of locally advanced esophageal squamous cell carcinoma. Methods: from October 2002 to April 2011, 86 patients with esophageal cancer were admitted to Sichuan Provincial Cancer Hospital. There were 41 patients with 30 Gy / 10 times / 2 weeks in group A and 45 patients with 40 Gy / 20 / 4 weeks in group A and 45 patients with 40 Gy / 20 / 4 weeks in group A and group A received 5-fluorouracil 300 mg / m ~ 2 intravenously for d _ (1-3) and cisplatin 30 mg / m ~ (2) intravenously for d _ (1-321) to 28 days for a period of two cycles. Radiotherapy and chemotherapy were performed at the same time, and surgery was performed 3-4 weeks after the end of radiotherapy and chemotherapy. Operation: for upper thoracic cancer of esophagus, incision was made from neck, right chest and upper abdomen, and esophagus and stomach were anastomosed. The lymph nodes of the second field were dissected. For the middle and lower thoracic carcinoma of esophagus, the incision was made from the right chest and the upper abdomen, the esophagus and stomach thorax were anastomosed, and the lymph nodes of the second field were dissected. The clinical data of the two groups were examined by 蠂 2 test. The survival analysis was compared by kaplan-Meier regression model and Cox regression model. All the statistical tests were carried out with bilateral test. The efficacy of the test was 0.8P 0.05. The main end point of the study was the R0 resection rate and the pCR rate of the patients. Survival rate. The end point of the study was treatment-related adverse reactions. Results the stage reduction rates of group A and group B were 68.3% and 55.60.The R0 resection rates were 95.1 and 88.9 respectively, and the CR rates were 31.7% and 24.40.27, respectively. There was significant difference between the two groups. The OS of the treatment group was 78.1% and 68.9%, respectively, and 43.9% and 44.4%, respectively. There was no statistical difference between the two groups in radiation-induced esophagitis. Radiation pneumonia, leukopenia, There was no significant difference in the rate of anastomotic fistula and wound delayed healing (P 0.05). The rate of R0 resection was higher than that of routine chemotherapy group (P 0.05%). The overall survival rate and side effects occurred in the two groups. There is no statistical difference in the rate. Univariate analysis suggests, The prognostic factors of patients' survival were pre-radiotherapy stage, physical state score, tumor length, whether the stage decreased after radiotherapy and whether the pathological remission was achieved after radiotherapy. Multivariate analysis showed that the stage before radiotherapy and the score of physical condition were the prognostic factors affecting the survival of the patients. Conclusion: compared with conventional radiotherapy, preoperative high fractionation radiotherapy has better R0 resection rate and pCR rate than conventional radiotherapy, and whether or not to achieve pathological remission after radiotherapy is an independent factor affecting the prognosis of the patients, conclusion: compared with conventional radiotherapy, preoperative high fractionation radiotherapy has a better R0 resection rate and a better pCR rate than conventional radiotherapy. But there was no difference in survival rate between the two groups. Preoperative fractionated radiotherapy did not increase the incidence of treatment-related radiation esophagitis, radiation pneumonia, leukopenia, anastomotic fistula and delayed wound healing, and had a short treatment period. It can shorten the duration of hospitalization, save the cost of hospitalization, and be more easily accepted by patients. The prognosis of patients who achieved pathological remission after radiotherapy was better than that after radiotherapy. At present, high fractionation radiotherapy and conventional fractionation radiotherapy can be used as partitioning modes for local advanced esophageal cancer. The specific treatment should be decided according to the individual condition of the patient.
【學(xué)位授予單位】：西南醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R735.1

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