食管癌三维适形常规分割与后程加速超分割放疗120例初步分析

目的 比较三维适形放疗(3D-CRT)和后程加速超分割(LCAF)适形放疗食管癌的疗效和不良反应,为中、晚期食管癌根治性放疗提供参考方案.方法 120例符合入组条件的食管癌患者分成两组:3D-CRT组65例,照射剂量60～70 Gy,每次2 Gy,每周5次,中位剂量66 Gy;LCAF组55例,前程为传统常规分割放疗,照射剂量30 Gy,后程改为加速起分割放疗,每次1.5 Gy,每天2次,照射剂量30～39 Gy,总剂量60～69 Gy,中位剂量63 Gy.结果3D-CRT组.1、2年局部控制率分别为88.1%和79.0%,较LCAF组的81.9%和62.9%高,但两组比较差异无统计学意义(均P0.05),而两组3年局部控制率分别为74.4%和47.9%,差异有统计学意义(P=0.003);两组1、2,3年生存率比较差异均无统计学意义(P0.05);3D-CRT组放射性食管炎发生率较LCAF组低,但差异无统计学意义(P=0.581),放射性肺炎发生率分别为12.3%和27.3%(P=0.036).结论 食管癌3D-CRT的局控率、近期生存率稍优于后程加速超分割放疗;并且其不良反应较LCAF组轻.

Comparison of esophageal carcinoma treated by three-dimensional conformal radiotherapy and late course accelerated hyperfraction radiotherapy

Objective To compare the lately survival and the radiation side effects in esophageam carcinoma treated by three-dimensional conformal radiotherapy(3D-CRT) and late course accelerated hyperfraction radiotherapy(LCAF).Methods One hundred and twenty patients of esophageal carcinoma were divided into two groups by different radiotherapy models.Sixty-five patients were treated by 3D-CRT to a total dose 60-70 Gy,2 Gy a time,5 times a week,median dose 66 Gy;Fifty-five patients were treated by LCAF(first treated by conventional separation radiotherapy) to the dose 30 Gy,later treated by LCAF,1.5 Gy a time,2 times a day,30-39 Gy,a total dose 60-69 Gy,median dose 63 Gy.Results The 1-,2-year local control rates in 3D-CRT group were 88.1%,79.0% compared to 81.9%,62.9% in LCAF group(P>0.05).But the 3-year local control rate in 3D-CRT group was significantly higher than that of LCAF group(74.4% vs 47.9%,P=0.003).The survival rates of 1-,2-,3-year in 3D-CRT group were insignificant compared to those of LCAF group(P>0.05).In 3D-CRT group,the incidence of radiation-induced esophagitis was lower than that in LCAF group(P=0.581),and the rate of radiation-induced pneumonitis was significantly lower in 3D-CRT than in LCAF(12.3% vs 27.3%,P=0.036).Conclusion The 1-,2-and 3-year local control and survival rate of patients with esophageal carcinoma treated by 3D-CRT are superior to LCAF radiotherapy.And the radiation side effects in 3D-CRT group are less than those in LCAF group.