【论文关键词】食管肿瘤；多西他赛；顺铂

　　【论文摘要】目的：探讨多西他赛联合顺铂治疗晚期食管鳞癌的疗效和不良反应。方法：30例晚期食管癌患者，期中20例为初次化疗患者，10例为曾接受手术后辅助化疗。中位年龄54岁。多西他赛75 mg/m2，d1、静脉滴注1小时；顺铂４０ mg/m2，d2，d3；21天为1周期。结果：30例患者共完成93个化疗周期。在可评价的28例患者中，完全缓解4例（14.2%），部分缓解13例（42.8%），有效率为（57.1%），中位疾病进展时间为5.2个月，中位生存时间为9.5个月。可评价不良反应28例，其中主要的不良反应为脱发，有4例（14.2%），患者出现Ⅲ～Ⅳ度粒细胞降低。结论：多西他赛联合顺铂治疗晚期食管癌疗效肯定，可以考虑作为治疗晚期食管癌的主要治疗方案。
　　
　　
　　Study of docetaxel and cisplatin for advanced squamous-cell carcinoma in esophagus
　　　　
   【Abstract】Objective：Docetaxel was used in a phase Ⅱ trial in the combination with cisplatin for esophageal cancer.The anti-tumor response，toxicity and suevival of the treated patients were evaluated. Methods：Thirty patients with advanced unresectable or complicated with metastasis were allotted，twenty patients were primary chemotherapy while ten patients received adjuvant chemotherapy after operation.Patrents were given docetaxel 75 mg/m2 by 1-hour infusion on the first day，and cisplatin ４０ mg/m2 daily on the second day and the third day.Treatment was recycled every 21 days.Results：Thirty patients completed a median of 2 cycles and 28 patients were evaluable for response.Major objective responses were observed in 16 patients（57.1%），including 4 complete response（14.2%），and 12 partial response（42.8%）. The median time to tumor progression was 5.2 months. The median actuarial survival was 9.5 months.Twenty-eight patients were assessable for toxicity.The most common nonhematologic toxicity was alopecia.Grade 3 to 4 nentropenia was observed in 13.3﹪ of the pantients.Conclusion：The combination of docetaxel and cisplatin can be considered as a main regimen in the treatment of advanced esophageal cancer .
　　【Key words】Esophageal tumor；Docetaxel；Cisplatin
　　
　　研究证明，紫杉类药物是目前治疗食管癌最有效的药物，单药有效率在32%。紫杉类联合铂类化疗治疗术前和晚期食管癌国外报道有效率为50%～60%。我院自2002年3月~2004年2月采用多西他赛联合顺铂治疗30例晚期食管癌，结果报道如下：
　　
　　1 资料与方法
　　
　　1.1 入选标准：全组患者在X线片、CT扫描片上均可测量病灶大小，K，S评分≥60分；预计生存≥3个月，血常规、肝功能、血糖测定均在正常范围。
　　1.2 病例资料：本组男20例，女10例。年龄35~74岁，中位年龄54岁。全部患者均经细胞学或病理学证实为食管鳞癌，其中Ⅲ期4例、Ⅳ期26例（肝转移6例，肺转移9例）。有10例曾行手术后期辅助化疗，26例为初期化疗患者。
　　1.3 治疗方法：多西他赛75 mg/m2，静脉滴注1小时d1，顺铂 40 mg/m2，静脉滴注d2、3，给与水化，21天为1个周期。化疗有效最多为6个周期。用多西他赛时前1天、当天，给药后1天，给与地塞米松，口服抗过敏。化疗期间给与5-羟色胺受体阻滞剂止呕治疗，Ⅱ度听力损害时，顺铂减量至30 mg/m2，Ⅲ度听力损害时，停用顺铂。