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摘要: [目的]观察化放疗与介入化疗及免疫栓塞治疗局部晚期胃食管结合部位腺癌的疗效及安全性。[方法]选用43例经活检证实不可手术根治性切除的局部晚期食管胃结合部位肿瘤患者随机分为介入化疗免疫栓塞组(A组20例)和放化疗组(B组23例)。介入化疗免疫栓塞法为经右股动脉插管至胃左动脉灌注[(奥沙利铂(OXA):100 mg,表阿霉素(EPI):40 mg, 5-氟尿嘧啶(5-FU):1.0 g,沙培林20k]并用适量明胶海绵栓塞;放化疗组采用三野适形放疗(DT:4500CGY/180CGY/25F)配合FOLFOX4方案同步化疗。[结果]①A组PR16例(80%),SD 4例(20%);B组PR 11例(47%),SD12例(53%),A组近期疗效明显优于B组(P＜0.05);经过治疗争取手术根治切除的患者分别是10例和9例,差异无统计学意义;②2组的Ⅲ~Ⅳ度不良反应发生率差异无统计学意义(P＞0.05);③2组平均无疾病进展生存时间分别为:19.851月(95%CI:18.245-21.454月)和16.884月(95%CI:15.474-18.294月);中位无疾病进展时间分别是21月(95%CI:17.393-24.607月)和17月(95%CI:16.038-17.962月)(P＜0.05),差异有统计学意义。[结论]对于不可手术切除的局部晚期食管胃结合部位腺癌的治疗,2组毒性反应相当,无论是近期疗效还是无疾病进展生存时间,介入化疗免疫栓塞治疗组明显优于放化疗组。
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