临床T2NOMO胸上中段食管癌的后程加速超分割放疗

目的 分析临床T2NOMO胸上中段食管癌后程加速超分割放射治疗的疗效、副反应及失败原因。方法 回顾分析后程加速超分割放射治疗临床分期T2NOMO胸上、中段食管鳞癌53例,放射方法均为前2／3疗程常规放疗,每次1.8Gy,共41．4Gy左右;后1／3疗程缩野改为加速超侵害放射治疗,每天2次,1.5Gy／次,共27Gy左右。全疗程40－49d,总剂量为67－70Gy/40-43Fx。结果 53例患者1,2,5年生存率分别为89．9％、66．8％和51．2％;1,2,5年局控率分别为92．1％、87．1％和87．1％。死亡17例,其中死于未控和局部复发5例,占29．4％;远处转移9例（含2例伴有淋巴结转移）,占52．9％;淋巴结转移5例（含2例伴有远处转移）,占29．4％;食管出血1例,占5．9％。多因素分析显示,病变部位是其独立的预后因素,胸上段优于胸中段。结论 后程加速超分割放射治疗可作为治疗胸上、中段早期食管鳞癌的首选方法之一。

Late course accelerated hyper-fractionated radiotherapy of upper and middle thoracic esophageal T2N0M0 carcinoma

OBJECTIVE: To analyse the result of late course accelerated hyper-fractionated radiotherapy (LCAHFR) of upper and middle thoracic segment esophageal T2N0M0 carcinoma. METHODS: Fifty-three patients with squamous cell esophageal T2N0M0 carcinoma in the upper and middle segment were treated by LCAHFR from August 1994 to January 2000. The design of the radiation fields were based on CT and barium examination. All patients were treated with the conventional fractionated radiotherapy during the first two-thirds of the treatment to a dose about 41.4 Gy/23 F/4 to 5 weeks. This was followed by accelerated hyper-fractionated irradiation using reduced fields, twice daily at 1.5 Gy per fraction to a dose about 27 Gy/18 d. Thus, the total dose was 67-70 Gy/40-43 F/40-49 d. RESULTS: The 1-, 2- and 5-year actuarial survival rates were 89.9%, 66.8% and 51.2%, respectively. The 1-, 2- and 5-year local control rates were 92.1%, 87.1% and 87.1%. Of the 17 patients who died, 5 died of local failure (29.4%), 9 (52.9%) of distant metastasis, 5 (29.4%) of lymph metastasis and 1 (5.9%) of bleeding from the esophagus. The Cox multivariate model showed that the site of lesion was the only prognostic factor, with upper better than the middle segment. CONCLUSION: Late course accelerated hyper fractionated radiotherapy is one of the best radiation treatment regimen for early esophageal carcinoma in the upper and middle thoracic segment.