立体定向适形放疗剂量对晚期胆管癌治疗疗效的影响

目的：探讨立体定向适形放疗(3D-CRT)剂量对不可切除的胆管癌治疗疗效的影响。方法：对48例不能手术切除的局部晚期胆管癌患者采用3D-CRT技术，根据放疗剂量分为3组，低剂量组12例，DT33～39Gy，中等剂量组23例，DT40—58Gy，高剂量组13例，DT59．4—68Gy。低剂量组3Gy／次，中等剂量组及高剂量组1．8—2．0Gy／次，5次／周。结果：所有患者局部复发的中位时间是10月，中位总生存期是12月。影像学显示24例(50％)疾病进展，其中21例(87．5％)以局部复发作为疾病进展的第一影像学证据，其余3例出现远处转移。3组间局部复发时间(P=0．220)及中位生存时间(P=0．232)差异无显著性。急性胃肠道反应发生率在各放疗剂量组差异无显著性(P=0．485)。结论：局部进展是本组胆管癌治疗失败的主要原因。虽然因本研究病例数较少不足以进到统计处理，但高放疗剂量组具有局部控制率较高、总生存期较长的趋势。

Effect of doses of three-dimensional conformal radiotherapy for unresectable biliary cancer

Purpose:To determine the effect of doses of three-dimensional conformal radiotherapy(3D-CRT) for unresectable biliary cancer. Methods:48 patients with localized,unresectable cholangiocarcinoma were treated with 3D-CRT.Patients were grouped according to the radiotherapy dose: 12 patients received a total dose of 33-39Gy(low dose group),23 patients received 40-58Gy(medium dose group),and 13 patients received 59.4-68Gy(high dose group). The low dose group received 3Gy/fraction,medium dose group and high dose group received either 1.8 or 2Gy/fraction,5 fraction/week. Results:The median time to local progression for all patients was 10 months. The median overall survival was 12 months. 24(50%)had radiographic evidence of disease progression. 21 of those patients(87.5%) experienced local recurrence as the first radiographic sign of disease progression. The remaining 3 presented with metastatic disease as the initial sign of progression. The time of local failure(P=0.220) and the median survival(P=0.232) were not statistically different among the three groups. The rate of acute gastrointestinal side effects was not statistically different among the three groups(P= 0.485) . Conclusions:Local progresion was the predominant pattern of disease recurrence in this group of patients with unresectable biliary cancer. Because the power to detect even large difference with small numbers of patients is limited,a benefit from high dose radiotherapy cannot be excluded.