【摘要】 目的探讨不同剂量放疗联合同期顺铂化疗根治性治疗晚期食管癌疗效。方法选取2015年1月至2017年12月间江苏省南通市肿瘤医院收治的68例食管鳞癌患者为研究对象。根据放疗剂量不同进行分组,每组34例。所有患者均采用放疗联合同期顺铂化疗。其中,放疗剂量为60Gy治疗的34例患者纳入对照组,放疗剂量为50Gy治疗的34例患者纳入研究组。观察两组患者治疗前后血清学和免疫功能变化并比较,观察两组患者治疗后的治疗效果、并发症、生存期和肿块控制率变化情况。结果治疗前,两组患者各血清学指标比较,差异无统计学意义(P> 0. 05)。治疗后,研究组白细胞计数较治疗前均显著升高,D-二聚体、血小板平均体积、纤维蛋白原和丙氨酸转氨酶较治疗前显著下降,且研究组上述指标显著优于对照组,差异均有统计学意义(均P <0. 05)。治疗前,两组患者各指标比较,差异无统计学意义(P> 0. 05)。治疗完成后,研究组免疫球蛋白A(IgA)、IgG、IgM、CD4~+和CD4~+/CD8~+较治疗前均显著升高,CD8~+较治疗前显著下降,且研究组显著优于对照组差异均有统计学意义(均P <0. 05)。两组患者治疗总有效率比较,差异无统计学意义(P> 0. 05)。研究组患者的胃肠道反应、白细胞减少、放射性食管炎和急性放射性肺炎各等级发生率均低于对照组患者,差异均有统计学意义(均P <0. 05)。研究组1年局部区域控制率和1年无远处转移生存率均高于对照组,差异均有统计学意义(均P <0. 05)。结论低剂量放疗联合同期顺铂化疗根治性治疗晚期食管癌疗效可靠,能降低并发症,同时能提高生存期和免疫功能。更多还原

【Abstract】 Objective To explore the treatment efficacy of different doses of radiotherapy combined with cisplatin chemotherapy in the radical treatment of advanced esophageal cancer. Methods A total of 68 patients with esophageal squamous cell carcinoma treated at Nantong Cancer Hospital from January 2015 to December 2017 were selected and were divided into a study group and a control group according to the radiotherapy dose with 34 patients in each group. All the patients were treated with radiotherapy combined with concurrent cisplatin chemotherapy. The study group was given 50 Gy of radiation and the control group was given 60 Gy of radiation. The changes in serum and immune function before and after treatment were observed and compared between the two groups. The changes of treatment effectiveness,complications,survival time and mass control rate after treatment were observed. Results There was no significant difference in serum indexes between the two groups before the treatment and after treatment（ all P > 0. 05）. White blood cell count（ WBC） increased significantly in the study group after the treatment,while D-Dimer（ D-D）,platelet count（ PLT）,mean platelet volume（ MPV）,fibrinogen（ FIB） and alanine aminotransferase（ ALT） decreased significantly and the above levels were higher in the study group than in the control group（ all P < 0. 05）. There was no significant difference in immunoglobulin A（ Ig A）,Ig G,Ig M,CD4⁺,CD4⁺/CD8⁺and CD₈⁺between the two groups before the treatment（ all P > 0. 05）. After the treatment,the levels of Ig A,Ig G,Ig M,CD4⁺and CD4⁺/CD8⁺significantly increased in the study group and CD8⁺significantly decreased with the levels in study group better than in the control group（ all P < 0. 05）. There was no significant difference in the overall efficacy rate（ P > 0. 05）. The incidence of gastrointestinal reactions,leukopenia,radiation esophagitis and acute radiation pneumonia was significantly lower in the study group than in the control group（ all P < 0. 05）. The 1-year local control rate and 1-year free distant metastasis survival rate were significantly higher in the study group than in the control group（ all P < 0. 05）.Conclusion Radiotherapy combined with cisplatin in the treatment of non-operative esophageal cancer is effective and reliable. It can not only reduce complications,but also improve survival and immune function.更多还原