【摘要】：目的:本研究通過回顧性分析70歲以上中晚期食管鱗癌患者,治療上使用放化療方案與單純放療方案進行對比,對患者的安全性和可能會影響到生存的相關(guān)預后因素進行評價、分析和總結(jié),以探討放化療比單純放療是否能使老年食管鱗癌患者獲益更加明顯,為更好的臨床醫(yī)生優(yōu)選老年食管癌患者的治療方案提供參考。方法:回顧性分析了我院62例經(jīng)病理確診,2008年3月至2016年6月接受放化療或單獨放療的非手術(shù)治療的70歲以上中晚期食管鱗癌患者的臨床資料。其中放化療組共28例,單純放療組共34例。放療技術(shù)上采用調(diào)強放療,處方劑量:6MV-X線,PGTV56.0-68.2Gy/28-31f,PCTV50.4-60Gy/28-31f�；煼桨覆捎肈F方案或TP方案。觀察兩組患者的毒副反應,評價近期療效并進行生存分析。結(jié)果:單獨放療組與放化療組的1、2、3年生存率分別為56.4%、27.6%、13.8%和75.0%、42.3%、29.9%,兩組總生存差異有統(tǒng)計學意義,P=0.043。單因素分析的結(jié)果顯示,性別、吸煙史、飲酒史、合并癥、體重下降、腫瘤部位、N分期、劑量分組與預后無關(guān),而臨床分期、腫瘤長度、T分期、ECOG分、近期療效成為影響患者生存的預后因素。多因素分析結(jié)果得出近期療效成為影響患者生存的獨立預后因素。治療結(jié)束觀察近期療效,總有效率(ORR)單獨放療組64.7%,放化療組92.8%,P=0.008,比較有統(tǒng)計學意義。單獨放療組與放化療組均出現(xiàn)1至3級白細胞減少,3級白細胞減少發(fā)生率分別2.9%和21.4%,兩組白細胞減少比較具有統(tǒng)計學意義P=0.015;單獨放療組出現(xiàn)1、2級中性粒細胞減少,未發(fā)生3級以上反應。放化療組出現(xiàn)1至4級中性粒減少,3級以上反應發(fā)生率是25%,兩組中性粒細胞減少比較具有統(tǒng)計學意義P=0.008。胃腸道反應方面,單獨放療組出現(xiàn)1級反應的發(fā)生率為14.7%,未出現(xiàn)更高級別反應,放化療組均發(fā)生1至3級胃腸道反應,3級以上反應的發(fā)生率為7.1%,兩組胃腸道反應比較具有統(tǒng)計學意P=0.000。結(jié)論:在老年食管鱗癌患者中,放化療在近期客觀療效優(yōu)于單獨放療組,且在遠期預后方面能夠提高患者的1、2、3年總生存期。多因素分析顯示T分期成為影響患者生存的獨立預后因素。在毒副反應方面,老年食管鱗癌患者在放化療組比單獨放療組出現(xiàn)白細胞減少、中性粒細胞減少的血液毒性及胃腸道反應更為明顯,尤其是3級以上的毒副反應。
[Abstract]:Objective: to evaluate the safety of patients with esophageal squamous cell carcinoma (ESCC) over 70 years of age and the prognostic factors associated with survival by comparing radiotherapy and chemotherapy regimen with radiotherapy alone. To explore whether radiotherapy and chemotherapy can benefit the elderly patients with esophageal squamous cell carcinoma more obviously than radiotherapy alone, and to provide a reference for the better clinicians to select the treatment plan for the elderly patients with esophageal cancer. Methods: the clinical data of 62 patients with advanced esophageal squamous cell carcinoma over 70 years old who received radiotherapy and chemotherapy or radiotherapy alone from March 2008 to June 2016 were retrospectively analyzed. There were 28 cases in radiotherapy and chemotherapy group and 34 cases in radiotherapy alone group. Intensity modulated radiotherapy, prescription dose: 6MV-X line, PGTV56.0-68.2Gy/28-31f,PCTV50.4-60Gy/28-31f. Chemotherapy regimen was DF or TP regimen. The toxicity and side effects of the two groups were observed, the short-term efficacy was evaluated and survival analysis was carried out. Results: the 1- and 3-year survival rates in radiotherapy alone group and radiotherapy and chemotherapy group were 56.4% and 27.6%, respectively, and 75.0% and 42.3%, respectively. There was significant difference in total survival between the two groups (P < 0.043). Univariate analysis showed that sex, smoking history, alcohol consumption history, complications, weight loss, tumor location, N stage, dose group were not associated with prognosis, but clinical stage, tumor length, T stage, ECOG score. The short-term curative effect has become a prognostic factor affecting the survival of patients. The results of multivariate analysis showed that the short-term outcome was an independent prognostic factor affecting the survival of patients. At the end of the treatment, the total effective rate was 64.7 in (ORR) alone radiotherapy group and 92.8 in radiotherapy and chemotherapy group, which was statistically significant. The leukopenia of grade 1 to 3 was found in radiotherapy group and radiotherapy group, and the incidence of leukopenia in grade 3 was 2.9% and 21.4respectively. There was significant difference in leukopenia between the two groups (P0. 015). In the radiotherapy alone group, grade 1 and 2 neutrophils decreased, but no grade 3 reaction occurred. In the radiotherapy and chemotherapy group, the neutropenia of grade 1 to 4 was found, and the rate of reaction above grade 3 was 25. The neutropenia in the two groups was significantly higher than that in the control group (P < 0. 008). In terms of gastrointestinal reaction, the incidence of grade 1 reaction in radiotherapy alone group was 14.7, and no higher grade reaction was found. In radiotherapy and chemotherapy group, the incidence of grade 1 to 3 grade gastrointestinal reaction was 7. 1%, and the incidence of grade 3 reaction was 7. 1%. The gastrointestinal reaction of the two groups was statistically significant (P = 0.000). Conclusion: in the elderly patients with esophageal squamous cell carcinoma, the objective curative effect of radiotherapy and chemotherapy in the near future is better than that in the radiotherapy alone group, and the long-term prognosis can improve the overall survival time of 1, 2 and 3 years in patients with esophageal squamous cell carcinoma. Multivariate analysis showed that T stage was an independent prognostic factor. In the side effects, leukopenia, neutropenia and gastrointestinal reaction were more obvious in the elderly patients with esophageal squamous cell carcinoma than in the radiotherapy group, especially in the grade 3 group.
【學位授予單位】：廣西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R735.1

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本文編號：2383834