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[目的]探讨提高食管鳞癌化疗的局部病灶反应率的方法。[方法]使用顺铂(DDP)+氟尿嘧啶(5-Fu)全身化疗联合内镜下瘤体注射丝裂霉素C+5-Fu治疗非广泛期非手术适应证食管鳞癌。全身化疗DDP20mg/m2,静滴,d1～4,5-Fu300mg/(m2·d),静滴,d1～5。5-Fu同步应用叶酸片20mg/次,3次/d,21d一个周期,两周期评价疗效。常规胃镜操作,镜下在肿瘤四周及顶部3～5注射点瘤体注射药物:5-Fu250mg、丝裂霉素(MMC)2mg。每周一次,两周休一周,一个疗程3～5次。[结果]全组共计69例可评价病例共完成132个周期。CR20例(28.98%)、PR34例(49.27%)、SD15例(21.73%),总获益率100%,总反应率(CR+PR)78.26%(54/69)。55例患者治疗结束不久进食困难症状得到改善。中位疾病进展时间10.0个月,1年生存率84.09%(37/44)。瘤体注射术后无食管穿孔发生,食管疼痛者6例,病灶渗血7例,对症处理后可缓解。药物相关不良反应发生状况总体轻微。主要副反应包括恶心呕吐Ⅰ度55.07%(38/69),Ⅱ度33.33%(23/69)。白细胞下降发生率34.78%(24/69),Ⅲ～Ⅳ度下降为10.14%(7/69)。[结论]全身化疗联合瘤体注射是一种单纯利用化疗方法来提高食管鳞癌局控率的良好途径。
[Objective] To explore the method to improve the local lesion response rate in esophageal squamous cell carcinoma chemotherapy. [Method] The combination of cisplatin (DDP) + fluorouracil (5-Fu) systemic chemotherapy combined with endoscopic tumor injections of mitomycin C + 5-Fu for non-extensive indications of esophageal squamous cell carcinoma. Intravenous drip, d1 ~ 4,5-Fu300mg / (m2 · d), intravenous drip, d1 ~ 5.5-Fu with 20mg / Two cycles to evaluate the efficacy. Conventional endoscopy, microscopy in the tumor around the top and 3 to 5 injection point tumor injection of drugs: 5-Fu250mg, mitomycin (MMC) 2mg. Once a week, two weeks off a week, a course of 3 to 5 times. [Results] A total of 69 evaluable cases were completed in the whole group for 132 cycles. CR20 cases (28.98%), PR34 cases (49.27%), SD15 cases (21.73%), total benefit rate 100% and total response rate 78.26% (54/69). 55 patients improved symptoms of eating difficulties shortly after the end of treatment. The median time to progression was 10.0 months, and the 1-year survival rate was 84.09% (37/44). There was no esophageal perforation after tumor injection. There were 6 cases of esophageal pain and 7 cases of bleeding in the lesion, which were relieved after symptomatic treatment. The overall incidence of drug-related adverse events was mild. The main side effects include nausea and vomiting Ⅰ degree 55.07% (38/69), Ⅱ degree 33.33% (23/69). The incidence of white blood cells decreased 34.78% (24/69), Ⅲ ~ Ⅳ decreased to 10.14% (7/69). [Conclusion] Systemic chemotherapy combined with tumor injection is a good way to improve the control rate of ESCC with chemotherapy alone.