CT模拟定位三维适形放射治疗食管癌的临床研究

目的探讨CT模拟定位三维适形放射治疗食管癌的疗效。方法1997年4月～2002年7月,经病理证实的食管鳞状细胞癌87例患者，其中男性56例，女性31例，年龄42～75岁，平均年龄62.5岁，随机分为2组，两组患者一般情况、性别、年龄及病变部位构成经统计学检验无统计学意义，一组为采用CT模拟定位进行三维适形放射治疗，另一组为常规模拟定位放射治疗，两组的剂量都为64～66Gy／32.33次／6.4～6.6周。结果采用Kaplan—Meier法计算生存率，并用Log—Rank检验其差异性。治疗计划各指标分析采用kolmogorowSmirnov法行正态分布检验，继而行t检验，以P〈0.05为差异有统计学意义。CT模拟定位三维适形放射治疗组和常规模拟定位放射治疗组1、2、3、4年生存率分别为70.1％、55.6％、40.4％、36.3％和65.4％、50.6％、30.6％、20.9％（p〉0.05）。但是对Ⅰ～Ⅱ期患者，CT模拟定位三维适形放射治疗组和常规模拟定位放射治疗组的生存率分别为81.2％、75.5％、67.3％、61.5％和80.1％、65.7％、54.9％、29.7％（P〈0，05），局部控制率分别为75.6％、71.7％、65.5％、59.0％和65.4％、50.6％、33.3％、25.6％（P〈0.05）。而对于Ⅲ～Ⅳ期的患者，两组之间的生存率和局部控制率差异无统计学意义。结论CT模拟定位三维适形放射治疗的疗效明显好于常规模拟定位放射治疗组。特别对Ⅰ-Ⅱ期早期食管癌患者两组之间差异有统计学意义，而对晚期患者差异无统计学意义。

CT simulation assisted 3D conformal radiotherapy in esophageal carcinoma

Objective To investigate the therapeutic effect of CT simulation assisted 3D conformal radiotherapy in treatment of esophageal cancer. Methods From April 1997 to July 2002,87 cases of esophageal cancer patients were randomly enrolled into 2 groups. Group 1 （n = 43 ） receiving whole course of conventional simulation assisted conventional radiotherapy and group 2 （n = 44） received whole course of CT simulation assisted 3D eonformal radiotherapy. General situation in these 2 groups had no significant difference by statistics test. All the patients in both groups received a total tumor dose of 64 - 66 Gy/32 - 33 fractionation for 6.4 - 6.6 weeks. Results The patient＇s survival rate was calculated by Kaplan-Meier and tested their significance by Log-Rank. The 1,2,3,4 year survival rate of the CT simulation assisted 3D-conformal radiotherapy group were 70.1%, 55.6 %,40.4 % and 36.3 % respectively in the conventional simulation assisted conventional radiotherapy group were 65.4 % ,50.6 % ,30.6 % ,20.9 % （P 〉 0.05） respectively,but for the stage Ⅰ - Ⅱ esophageal cancers,the survival rate of these 2 groups were 81.2 %,75.5 %,67.3 %, 61.5 % and 80.1% ,65.7 % ,54.9 % ,29.7 %（P〈 0.05） respectively.The local control rates were 75.6 % ,71.7 % ,65.5 % ,59.0 % and 65.4 % ,50.6 % ,33.3 % ,25.6 % （P 〈 0.05） respectively. But for the stage Ⅲ - Ⅳ patients,there was no significant differenee between the survival rate of 2 groups. Conclusion The effect of CT simulation assisted 3D eonformal radiotherapy is more favorable than that of the other groups and there is significant difference for stage Ⅰ - Ⅱ patients between 2 groups. But for advance patients, there is no significant difference in survival rate between 2 groups.