调强放射治疗联合替吉奥对老年食管癌的疗效研究

The efficacy of intensity-modulated radiation therapy combined with tegafur/gimeracil/oteracil in elderly patients with esophageal cancer

摘要:

目的 探讨调强放射治疗（IMRT）联合替吉奥治疗老年食管癌的临床疗效。方法 选取2019年2月1日—2022年2月28日皖南医学院第一附属医院弋矶山医院100例经病理证实的老年食管鳞癌患者，根据不同治疗方法分为单放组和联合组，各50例。单放组接受单纯调强放疗，联合组在调强放疗的基础上联合口服替吉奥胶囊。主要观察指标为临床疗效、2年中位总生存期（OS）和中位无进展生存期（PFS）；次要观察指标为治疗前后生活质量的变化、毒副反应（如放射性肺炎、放射性食管炎、中性粒细胞减少和消化道反应）发生率及治疗的总体安全性。结果 联合组客观缓解率、疾病控制率均高于单放组（P <0.05）。两组患者OS、PFS比较，差异均有统计学意义（P <0.05）。联合组共死亡26例，单放组共死亡33例。联合组治疗后肿瘤患者生活质量评分表（QOL）评分高于对照组（P <0.05）。治疗后单放组、联合组QOL评分均较治疗前升高（P <0.05）。联合组治疗前后QOL评分的差值均大于单放组（P <0.05）。单放组与联合组放射性肺炎率、放射性食管炎率、中性粒细胞减少率和胃肠道反应率比较，差异均无统计学意义（P >0.05）。结论 IMRT联合替吉奥治疗老年食管癌患者能有效提高治疗效果，且安全性良好，有助于提升患者的整体治疗体验和生活质量。

Abstract:

Objective To investigate the clinical efficacy of intensity-modulated radiation therapy (IMRT) combined with tegafur /gimeracil /oteracil (S-1) in the treatment of elderly patients with esophageal cancer.Methods A total of 100 cases of elderly patients with pathologically confirmed esophageal squamous cell carcinoma at our hospital from February 1, 2019 to February 28, 2022 were selected. Based on the different treatment strategies, the patients were assigned to either the radiotherapy-alone group or the combined-treatment group, with 50 cases in each. The radiotherapy-alone group received IMRT alone, whereas the combined-treatment group received oral S-1 in addition to IMRT. The primary endpoints included clinical efficacy, 2-year median overall survival (OS), and median progression-free survival (PFS). Secondary endpoints included changes in quality of life (QOL) before and after treatment, the incidence of adverse reactions including radiation pneumonitis, radiation esophagitis, neutropenia, and gastrointestinal toxicity, and overall treatment safety.Results The combined-treatment group showed higher objective response and disease control rates compared with the radiotherapy-alone group. Both OS and PFS were significantly different between the two groups (P < 0.05). A total of 26 deaths occurred in the combined-treatment group and 33 deaths in the radiotherapy-alone group. Post-treatment QOL scores were significantly higher in the combined-treatment group than in the control group (P < 0.05). In both groups, QOL scores improved after treatment compared with baseline (P < 0.05). The changes in diastolic pressure, systolic pressure, and heart rate before and after treatment were greater in the combined-treatment group (P < 0.05). The incidences of radiation pneumonitis, radiation esophagitis, neutropenia, and gastrointestinal reactions did not differ significantly between the two groups (P > 0.05).Conclusions IMRT combined with S1 effectively improves therapeutic outcomes in elderly patients with esophageal cancer, with acceptable safety. This combination regimen enhances overall treatment experience and QOL.