42例放疗后复发食管癌三维适形放疗的疗效分析

目的 探讨三维适形放疗(3DCRT)在食管癌首程放疗后局部复发患者中应用的可行性、疗效和放射损伤及影响因素.方法 42例首程放疗后局部复发的食管癌患者,采用3DCRT技术进行二程放疗.放疗处方剂量中位值54 Gy(50～64 Gy),1.8～2.0 Gy/次,5次/周.结果 随访截至2008年12月31日,随访率为100%,其中随访满1、2年者分别为20、22例.42例患者中完全缓解7例,部分缓解31例,无进展4例.全组患者1、2年总生存率分别为60%和24%.全组≥2级放射性食管炎15例,其中2级13例,3级2例.≥2级放射性肺炎9例,其中2级8例,3级1例.≥2级血液学副反应3例,其中2级2例,3级1例.本组共死亡28例,其中死于局部复发9例、远处转移7例、食管瘘1例、食管狭窄1例、全身衰竭4例、心脏病3例、电解质紊乱1例、死因不明1例.结论 食管癌首程放疗后局部复发采用3DCRT二程放疗是可行的,有较好临床症状缓解率和即时疗效,部分患者可延长生存期;但再程放疗并发症较高,临床应用时应严格掌握其适应证.

Three-dimensional conformal radiotherapy for loco-regionally recurrent esophageal cancer after initial radiotherapy

Objective To evaluate the feasibility, therapeutic effects and normal tissue complications of three-dimensional conformal radiotherapy (3DCRT) for loco-regionally recurrent esophageal cancer after initial radiotherapy. Methods Between March 2001 and May 2007, 42 patients with loco-reigonal recurrent esophageal cancer after initial radiotherapy were treated with 3DCRT, including 27 male and 15 female with a median age of 67.5 years. Radiotherapy was delivered at 1.8 -2.0 Gy per fraction, 5 fractions per week, with a median total dose of 54 Gy. Treatment outcomes and normal tissue complications were assessed with WHO and RTOG/EORTC criteria. Results By December 31,2008, the follow-up rate was 100%. Twenty patients had follow-up time of 1 year and the remaining 22 had 2 years. The clinical symptom relief rate was 60%, and the response rate was 90.5% with a complete remission rate of 17% and partial remission rate of 74%. The overall 1- and 2-year survival (OS) rates were 60% and 24%. Grade 2 and grade 3 acute radiation esophagitis developed in 31% and 5% of the patients, respectively. Grade 2 and grade 3 acute radiation pneumonitis developed in 19% and 2% , respectively. Grade 2 and grade 3 acute radiation hematology toxicities developed in 5% and 2%, respectively. Conclusions For patients with loco-regional recurrences of esophageal cancer after initial radiotherapy, 3DCRT is feasible, with a good clinical symptom relief rate and immediate tumor response. However,the complication rate was high and the clinical indications should be strictly controlled.