目的 分析三维适形放疗联合化疗对中晚期食管癌患者预后及抑郁状态的影响.方法 选择2010年6月至2013年6月于本院初次诊断为局部中晚期食管癌的95例患者为研究对象,采用随机数表法将其分为观察组(48例)和对照组(47例),对照组患者采取单纯三维适形放疗,观察组患者采取三维适形放疗联合化疗,比较两组患者近期疗效、不良反应发生情况、治疗前后抑郁自评量表(self-rating depression scale,SDS)评分、总生存时间、肿瘤局部控制率及无远处转移率.结果 观察组患者近期总有效率显著高于对照组(P<0.05).观察组患者Ⅲ~Ⅳ级放射性食管炎和骨髓抑制发生率均显著高于对照组(P<0.05),总生存时间和无远处转移率均显著高于对照组(P<0.05),两组患者肿瘤局部控制率比较无显著差异(P>0.05).治疗前及治疗后3个月,两组患者SDS评分比较均无显著差异(P>0.05);治疗后3、6个月,两组患者SDS评分较本组治疗前均显著降低(P<0.05),且治疗后6个月观察组患者SDS评分显著低于对照组(P<0.05).结论 较单纯三维适形放疗,三维适形放疗联合化疗能够有效提高中晚期食管癌患者的近期疗效和生存率,同时有助于改善患者的抑郁状态,虽然治疗期间放射性食管炎和骨髓抑制的发生率有所增加,但患者仍可耐受.%Objective To investigate the effect of three dimensional conformal radiotherapy combined with chemotherapy on the prognosis and depressive state in patients with middle-advanced stage esophageal. Method 95 cases of patients with locally advanced esophageal cancer from June 2010 to June 2013 in our hospital were randomly divided into observation group (n=48) and control group (n=47), control group patients weretreated with three-dimensional conformal radiotherapy alone, while observation group patients were given three-dimensional conformal radiotherapy combined with chemotherapy. Compared the short-term curative effects, adverse reactions, self-rating depression seale (SDS) scores, overall survival, tumor local contorl rate and non-distant metastasis rate between the two groups.Result The total effective rate of observation group were significantly higher than that of control group (P<0.05). The radiation esophagitis and depression of bone marrow in gradeⅢ~Ⅳ of observation group were significantly higher than that of control group (P<0.05); the overall survival and non-distant metastasis rate of observation group were significantly superior to that of control group (P<0.05). There was no significant difference between the two groups in tumor local control rate (P>0.05). Before treatment and 3 months after treatment, there were no significant differences in SDS score between the two groups (P>0.05). 3 and 6 months after treatment, the SDS scores of the two groups were significantly lower than those before treatment (P<0.05); after treatment for 6 months, the SDS score of observation group was significantly lower than that of control group (P<0.05). Conclusion Compared with three-dimensional conformal radiotherapy, three-dimensional conformalradiotherapy combined with chemotherapy can improve the curative effect and survival rate in patients with advanced esophageal cancer, but also help to improve the depressive state of patients, although the incidence rate during the treatment of radiation esophagitis and bone marrow suppression has increased, but patients can still be tolerated.
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