食管癌三维适形放射治疗的随访结果

[目的]探讨三维适形放射治疗（3D-CRT）食管癌的生存情况及局部控制情况。[方法]回顾性分析2000年10月至2004年12月期间182例食管癌病人接受3D-CRT的随访结果。治疗方法：采用三野以上多野共面照射为主，少数病例用非共面照射；剂量50～70Gy／5～7周，2Gy／次，每周5次（有8例采用后程加速超分割方案）。[结果]全组中位生存时间21个月；1、2、3、5年总生存率分别为71.2％、47．5％、36．6％、29．5％；1、2、3、5年无病生存率分别为55．9％、38％、31．8％、26．6％；1、2、3、5年局部控制率70.3％、62．8％、56．1％、54．5％；食管肿瘤未控或复发仍是死亡的第一原因，占死因的46．6％。[结论]三维适形放射治疗食管癌可取得较好的生存率和局部控制率。     

三维适形放射治疗食管癌临床疗效分析

目的探讨三维适形放射治疗(3DCRT)食管癌的疗效及放射治疗反应。方法采用3DCRT方法治疗食管癌67例(3DCRT组,5～6Gy/次,隔日照射1次,共7～8次,总剂量40～42Gy,13～15d),与同期行常规放射治疗(CF组,2.0Gy/次,5次/周,64～68Gy,44～48d)的112例食管癌进行比较。结果CF组和3DCRT组的1、2、3、4年局部控制率分别为53.6%、43.8%、33.9%、25.9%和71.6%、62.7%、49.3%、43.3%(P=0.011)。CF组和3DCRT组的1、2、3、4年生存率分别为49.1%、41.1%、30.4%、22.3%和62.7%、52.2%、43.3%、38.8%(P=0.027)。3DCRT组放射性食管炎发生率较CF组高(P=0.003),血液系统及全身反应3DCRT组较CF组轻(P=0.007,0.021)。结论3DCRT能明显改善食管癌的局部控制率和生存率,近期放射反应及远期放射损伤均可耐受。     

颈段胸上段食管癌三维适形放射治疗疗效观察

目的　探讨三维适形放射治疗颈段胸上段食管癌的疗效和分析影响预后的因素。方法　回顾性分析 33例颈段胸上段食管癌患者接受三维适形放射治疗 ( 2Gy/次 ,5次 /周 ,总剂量 6 6～6 8Gy ,6～ 7周完成 )的疗效 ,生存分析采用Kaplan Meier法 ,多因素分析采用Cox比例风险模型。结果　 1、2、3年局部控制率分别为 87.9%、75 .8%、4 5 .5 % ;1、2、3年生存率分别为 78.8%、6 6 .8%、4 4 .2 % ,中位生存期 33个月 ;1、2、3年无瘤生存率分布为 72 .7%、6 0 .6 %、30 .3%。急性放射反应主要是急性放射性食管炎和急性放射性气管炎 ,多为 1、2级。多因素分析结果显示原发肿瘤浸润深度、淋巴结转移和病变长度是影响预后的主要因素。结论　三维适形放射治疗是治疗颈段胸上段食管癌的有效治疗方法。原发肿瘤浸润深度、淋巴结转移和病变长度对患者的预后有重要影响。     

老年食管癌三维适形与调强放射治疗疗效比较

目的比较老年食管癌三维适形放射治疗(3D-CRT)或调强放疗(IMRT)的疗效及其预后相关因素。方法回顾性分析153例65岁以上老年食管癌患者的临床资料,105例行3D-CRT、48例行IMRT,采用SPSS11.5统计软件比较分析生存率及预后影响因素。结果放疗后食管造影评价CR 71例、PR 78例、NR 4例,总有效率(CR+PR)为97.4%;全组1、3年生存率和局部控制率分别为70.6%、34.2%和76.2%、51.1%。3D-CRT与IMRT组资料相比,IMRT组胸中下段及淋巴结转移者较多、CT食管肿瘤最大径较大、放疗剂量更高、联合化疗者更多(P<0.05);而性别、年龄、T分期、放疗前进食情况及食管造影长度两组间比较差异无统计学意义(P>0.05)。3D-CRT与IMRT组1、3年生存率和局部控制率比较,差异无统计学意义(P>0.05),分层分析中两组生存率比较,差异无统计学意义(P>0.05)。全组单因素分析显示,治疗前进食情况、病变部位、T分期、淋巴结转移与否、食管造影显示病变长度、CT肿瘤最大直径、化疗和近期疗效与预后生存有关(P<0.05);Cox多因素分析仅化疗和CT肿瘤最大直径为独立预后因素(P<0.05)。结论老年食管癌IMRT与3D-CRT比较无明显生存优势,联合化疗及肿瘤最大直径小者放疗疗效较好,但需进一步前瞻性研究。     

食管癌三维适形放射治疗精确定位研究

目的：探讨提高食管癌三维适形放射治疗CT模拟精确定位的方法。方法：未经治疗的食管癌患者25例先X线透视,在体表用铅珠标记病变上下缘,然后经体位固定、模拟机定位、体膜上标记射野中心后进行CT扫描,通过局域网将扫描图像传送到治疗计划系统,另8例未经X线透视标记病变上下缘直接CT模拟定位。根据食管造影、纤维食管镜和CT勾画GTV、CTV。当照射剂量达30Gy时,重新行CT扫描定位,勾画靶区。观察扫描后GTV长度、两次扫描后GTV最大横径、最大前后径、GTV几何中心点坐标及靶区移位情况。结果：不同定位方法肿瘤长度（8．23±2．43）cm与（6．48±1．73）cm有显著差异;两次定位后GTV最大横径及最大前后径比较有显著差异;二次定位靶中心复查移位率达60．0％;二次定位等中心点位置在X、Y、Z3个轴上分别相差（0．394±0．194）cm、（0．5872±0．3097）cm和（0．213±0．073）cm。结论：CT模拟定位能更充分显示肿瘤外侵范围并反映其非对称生长,但在确定病灶长度时不如钡餐透视,用CT定位时常规食管吞钡X射线仍有重要的参考价值,可将二者结合,对提高定位精度有重要帮助。同时食管癌放射治疗中二次定位,可纠正靶中心的误差,提高照射剂量准确性。     

食管癌三维适形放射治疗精确定位研究

目的:探讨提高食管癌三维适形放射治疗CT模拟精确定位的方法.方法:未经治疗的食管癌患者25例先X线透视,在体表用铅珠标记病变上下缘,然后经体位固定、模拟机定位、体膜上标记射野中心后进行CT扫描,通过局域网将扫描图像传送到治疗计划系统,另8例未经X线透视标记病变上下缘直接CT模拟定位.根据食管造影、纤维食管镜和CT勾画GTV、CTV.当照射剂量达30Gy时,重新行CT扫描定位,勾画靶区.观察扫描后GTV 长度、两次扫描后GTV最大横径、最大前后径、GTV几何中心点坐标及靶区移位情况.结果:不同定位方法肿瘤长度(8.23±2.43)cm与(6.48±1.73)cm有显著差异;两次定位后GTV 最大横径及最大前后径比较有显著差异;二次定位靶中心复查移位率达60.0%;二次定位等中心点位置在X、Y、Z 3个轴上分别相差(0.394±0.194)cm、(0.5872±0.3097)cm和(0.213±0.073)cm.结论:CT模拟定位能更充分显示肿瘤外侵范围并反映其非对称生长,但在确定病灶长度时不如钡餐透视,用CT定位时常规食管吞钡X射线仍有重要的参考价值,可将二者结合,对提高定位精度有重要帮助.同时食管癌放射治疗中二次定位,可纠正靶中心的误差,提高照射剂量准确性.     

食管癌三维适形放射治疗临床疗效观察

目的探讨三维适形放疗（3DCRT）应用于食管癌患者的可行性和临床结果。方法对30例经病理证实的食管癌患者实施三维适形放疗。处方剂量GTV为60-66 Gy,每次分割量180-210 cGy。治疗计划采用5-6个共面适形照射野,射线采用直线加速器的6MV X线照射。剂量参考线为90%等剂量曲线。以放疗结束时临床症状及放疗结束后3月的食管钡餐片作为评价依据。结果（1）29例在治疗结束时临床症状获得改善,近期有效率为96.7%。（2）1年生存率为66.7%;2年生存率为46.7%;3年生存率为36.7%。死亡12例,其中3例死于肺部感染,3例死于肿瘤广泛转移,1例穿孔,2例出血、狭窄,3例死因不明。（3）DVH显示肺受量V20在20%-30%以下,心脏和脊髓受量均能在正常范围内。急性食管反应级3例,级10例,级5例;急性放射性肺炎级2例。结论食管癌患者应用三维适形放疗是可行的,能够提高靶区的照射剂量和减少正常组织剂量,近期放射反应及远期放射损伤可望缓解。     

三维适形放射治疗食管癌预后因素分析

目的：评估三维适形放射治疗（3DCRT）食管癌的疗效、副反应及预后因素。方法：采用三维适形放射治疗经组织学证实的食管癌患者50例，2．0Gy／次，5次／周，总剂量60Gy-74Gy，其中单独放疗24例，序贯放化疗26例，分析患者的1、2、3、4年局控率、生存率和预后因素。结果：全组患者治疗后总有效率（CR＋Pa）为90％。1、2、3、4年局控率分别为76％、66％、62％、54％。1、2、3、4年生存率分别为76％、56％、40％、14％。放射性食管炎1级19例（38％），2级6例（12％），3级3例（6％）。白细胞减少1级11例（22％），2级8例（16％），3级2例（4％），4级1例（2％）。单因素分析显示临床分期、疗前进食状况、病变长度对生存率有影响。多因素分析显示临床分期和疗前进食状况是影响生存的独立预后因素。结论：食管癌采用3DCRT可得到较好的局控率和生存率以及较低的副反应发生率，临床分期和疗前进食状况是预后的影响因素。     

食管癌三维适形放射治疗剂量学与放射性肺炎发生相互关系的研究

目的:通过食管癌常规放射治疗与三维适形放射治疗的技术对比研究,比较应用不同外照射技术时肿瘤靶区适形指数的差异,以及肺等正常组织受照射容积剂量与放射性肺炎并发症发生概率(NTCP)的关系.方法:应用三维治疗计划系统,对28例胸中段EPC分别设计三种照射技术(A:常规3野;B:适形3野;C:适形5野).比较在同一处方剂量(66 Gy)时肿瘤靶区的适形指数,全肺受照射剂量与肺的NTCP的差异.结果:A、B、C三种照射技术比较:1)靶区的适形指数从0.55±0.09提高至0.76±0.04 和 0.78±0.06.2)肺平均剂量从(16.54±2.35) Gy降低至(13.26±1.93) Gy和(3.38±1.61) Gy;肺的V20从(32.95±6.43)%降低至(23.01±6.25)%和(24.8±4.47)%;肺的V30从(17.25±4.96)% 降低至(12.18±3.66)%和(6.75±2.93)%.3)肺的 NTCP从(6.9±6.86)%降低至(1.14±1.11)%和(1±1.02)%.A、B和C三种照射技术比较差异均有统计学意义,P=0.000.结论:三维适形放射治疗技术的靶区剂量分布较理想,显著降低正常肺的照射体积和剂量,减少放射性肺炎NTCP.     

三维适形放射治疗同步泰素治疗晚期食管癌

[目的]探讨局部晚期及术后复发性食管癌三维适形放射治疗（3DCRT）同步泰素化疗的临床疗效。[方法]36例局部晚期和术后复发性食管癌采用3DCRT结合泰素化疗（综合组）17例，单独应用3DCRT（对照组）19例。[结果]综合组和对照组疼痛缓解率分别为88.2％和78．9％，有效（CR＋PR）率分别为88．2％和84.2％，两组均无显著性差异（P〉0．05）。综合组1年、2年生存率分别为87．5％、62．5％．高于对照组（79％、28．7％）．但无显著性差异（P=-0．056），2年局部控制率分别为35．29％和21．05％．无显著性差异（P=0．06）。远处转移率分别为35．2％和63．1％，有显著性差异（P=0．045）。毒副反应方面两组相似（P〉0．05）。[结论]局部晚期和术后复发性食管癌临床上行三维适形放射治疗配合化疗可明显降低远处转移率及提高患者的近期生存率。     

食管癌后程三维适形放疗的临床疗效评价

Objective  

The aim of our study was to evaluate the clinical results and acute side effects of late course three-dimensional conformal radiotherapy (3DCRT) for esophageal carcinoma.     

食管癌三维适形后程加速放疗的临床研究

目的 利用三维适形放疗(3DCRT)技术对中晚期食管癌患者进行后程加速照射,对其疗效和副反应进行观察与分析.方法 55例首程治疗的食管癌患者接受3DCRT,随机分为3DCRT后程加速组(加速组,27例)和3DCRT常规分割组(常规组,28例),常规组处方剂量64～66 Gy分32～33次,加速组处方剂量67～70 Gy分29～30次,第5周开始加速照射3 Gy/次,5次/周.观察两组患者近期疗效、急性副反应及局部控制率、生存率和死亡原因.结果 加速组完全缓解率85%、部分缓解率15%、总有效率100%,常规组的分别为57%、43%、100%,加速组优于常规组(χ~2=5.24,P=0.022).两组1～5年局部控制率相似(χ~2=0.68,P=0.409),1～5年生存率也相似(χ~2=0.06,P=0.804).放射性食管炎发生率两组相近(85%:89%;χ~2=0.00,P=0.959),加速组放射性肺炎发生率略高于常规组(67%:43%;χ~2=3.14,P=0.076).加速组和常规组死亡分别为19、21例,其中局部控制失败分别为10、15例,远处转移分别为7、5例.结论 食管癌3DCRT后程加速放疗近期疗效满意,与3DCRT常规分割放疗相比局部控制率和远期生存率未见明显提高,后程加速照射有可能增加急性放射性肺及食管损伤但临床尚能接受.     

100例食管癌三维适形放疗疗效分析

%(χ2 =7.82,P=0.005).结论 食管癌3DCRT疗效确切,与历史资料比较局部控制率和生存率均有明显提高,治疗失败的主要原因仍然是局部未控制和复发,其次是远处转移.肿瘤穿透食管侵及邻近器官者治疗后穿孔、出血及远处转移的风险明显高于T分期较早者.     

后程加速超分割三维适形放疗食管癌的临床研究

目的 探讨食管癌后程加速超分割三维适形放疗的疗效及其预后相关因素.方法 回顾分析后程加速超分割三维适形放疗67例食管癌患者的临床资料,分析生存率、不良反应、死亡原因及预后影响因素.结果 中位随访时间16月.1、2、3、4年生存率分别为67.6％、50.9％、45.8％和35.9％,中位生存期为28月.Ⅰ～Ⅲ期食管癌1、2、3、4年生存率分别为76.9％、63.6％、57.3％,44.9％.单因素分析结果显示肿瘤部位、肿瘤长度、TNM分期对生存率有影响.Cox回归模型多因素分析结果表明肿瘤部位、肿瘤长度、TNM分期是独立预后因素,而性别、年龄与预后无关.死亡原因主要是局部未控或复发、淋巴结转移以及远处转移.结论　后程加速超分割三维适形放疗食管癌患者的局部控制率和生存率较常规治疗的历史水平明显提高,肿瘤部位、肿瘤长度、TNM分期是影响预后的独立因素.     

胸段食管癌三维适形放疗摆位误差研究

Objective To study the setup errors in three-dimensional conformal radiotherapy (3DCRT) for thoracic esophageal carcinoma using electronic portal imaging device(EPID) and calculate the margins from CTV to PTV. Methods Forty-one patients with thoracic esophageal carcinoma who received 3DCRT were continuously enrolled into this study. The anterior and lateral electronic portal images (EPI) were aquired by EPID once a week. The setup errors were obtained through comparing the difference between EPI and digitally reconstructed radiographs(DRR). Then the setup margins from CTV to PTV were calculat-ed. By using self paired design,22 patients received definitive radiotherapy with different margins. Group A: the margins were 10 mm in all the three axes;Group B: the margins were aquired in this study. The differ-ence were compared by Paired t-test or Wilcoxon signed-rank test. Results The margins from CTV to PTV in x,y and z axes were 8.72 mm, 10.50 mm and 5.62 mm, respectively. Between the group A and group B, the difference of the maximum dose of the spinal cord was significant(4638.7 cGy±1449.6 cGy vs. 4310.2 cGy±1528.7 cGy; t=5.48, P=0.000), and the difference of NTCP for the spinal cord was also significant (4.82%±5.99% vs. 3.64%±4.70%;Z=-2.70,P=0.007). Conclusions For patients with tho-racic esophageal carcinoma who receive 3DCRT in author's department,the margins from CTV to PTV in x, y and z axes were 8.72 mm, 10.50 mm and 5.62 mm, respectively. The spinal cord could be better protected by using these setup margins than using 10 mm in each axis.     

胸段食管癌三维适形放疗摆位误差研究

Objective To study the setup errors in three-dimensional conformal radiotherapy (3DCRT) for thoracic esophageal carcinoma using electronic portal imaging device(EPID) and calculate the margins from CTV to PTV. Methods Forty-one patients with thoracic esophageal carcinoma who received 3DCRT were continuously enrolled into this study. The anterior and lateral electronic portal images (EPI) were aquired by EPID once a week. The setup errors were obtained through comparing the difference between EPI and digitally reconstructed radiographs(DRR). Then the setup margins from CTV to PTV were calculat-ed. By using self paired design,22 patients received definitive radiotherapy with different margins. Group A: the margins were 10 mm in all the three axes;Group B: the margins were aquired in this study. The differ-ence were compared by Paired t-test or Wilcoxon signed-rank test. Results The margins from CTV to PTV in x,y and z axes were 8.72 mm, 10.50 mm and 5.62 mm, respectively. Between the group A and group B, the difference of the maximum dose of the spinal cord was significant(4638.7 cGy±1449.6 cGy vs. 4310.2 cGy±1528.7 cGy; t=5.48, P=0.000), and the difference of NTCP for the spinal cord was also significant (4.82%±5.99% vs. 3.64%±4.70%;Z=-2.70,P=0.007). Conclusions For patients with tho-racic esophageal carcinoma who receive 3DCRT in author's department,the margins from CTV to PTV in x, y and z axes were 8.72 mm, 10.50 mm and 5.62 mm, respectively. The spinal cord could be better protected by using these setup margins than using 10 mm in each axis.     

胸段食管癌三维适形放疗摆位误差研究

Objective To study the setup errors in three-dimensional conformal radiotherapy (3DCRT) for thoracic esophageal carcinoma using electronic portal imaging device(EPID) and calculate the margins from CTV to PTV. Methods Forty-one patients with thoracic esophageal carcinoma who received 3DCRT were continuously enrolled into this study. The anterior and lateral electronic portal images (EPI) were aquired by EPID once a week. The setup errors were obtained through comparing the difference between EPI and digitally reconstructed radiographs(DRR). Then the setup margins from CTV to PTV were calculat-ed. By using self paired design,22 patients received definitive radiotherapy with different margins. Group A: the margins were 10 mm in all the three axes;Group B: the margins were aquired in this study. The differ-ence were compared by Paired t-test or Wilcoxon signed-rank test. Results The margins from CTV to PTV in x,y and z axes were 8.72 mm, 10.50 mm and 5.62 mm, respectively. Between the group A and group B, the difference of the maximum dose of the spinal cord was significant(4638.7 cGy±1449.6 cGy vs. 4310.2 cGy±1528.7 cGy; t=5.48, P=0.000), and the difference of NTCP for the spinal cord was also significant (4.82%±5.99% vs. 3.64%±4.70%;Z=-2.70,P=0.007). Conclusions For patients with tho-racic esophageal carcinoma who receive 3DCRT in author's department,the margins from CTV to PTV in x, y and z axes were 8.72 mm, 10.50 mm and 5.62 mm, respectively. The spinal cord could be better protected by using these setup margins than using 10 mm in each axis.     

食管癌同期放化疗的临床观察

目的:观察中晚期食管癌同期放化疗与单纯放疗的毒副反应及疗效.方法:将中晚期食管癌患者155例分为同期放化疗组77例和单纯放疗组78例,两组患者均接受三维适形放疗或调强放疗,中位处方剂量均为60 Gy.化疗方案为顺铂、5-FU和亚叶酸钙针,于放疗开始的第1、5周同期给予,观察患者治疗完成情况和急性毒副反应及生存率、局控率并进行亚组分析.结果:1)同期组白细胞、血小板、血色素减少情况均高于单放组,P＜0.05.两组≥2级急性放射性食管炎发生率分别为51.95％ (40/77)和24.36％(19/78),x2＝12.510,P=0.000,中重度急性放射性肺炎发生率分别为15.58％(12/77)和3.85％(3/78),x2 =6.108,P=0.013.2)同期组与单放组1、2、3和4年局控率和总生存率差异均无统计学意义,P＞0.05.亚组分析未寻找到加入同期化疗后局控和生存获益的患者.3)局部控制失败仍然是患者死亡的主要原因,同期组与单放组死于远处转移患者的比率分别为28.6％( 10/35)和32.6％(14/43),x2=0.144,P=0.704.结论:食管癌精确放疗联合同期化疗有可能出现较重的毒副反应,患者总生存率、局控率及中位生存期有提高的趋势,但均未达统计学差异,临床价值需要进一步探讨.     

胸段食管癌三维适形放疗摆位误差研究

Objective To study the setup errors in three-dimensional conformal radiotherapy (3DCRT) for thoracic esophageal carcinoma using electronic portal imaging device(EPID) and calculate the margins from CTV to PTV. Methods Forty-one patients with thoracic esophageal carcinoma who received 3DCRT were continuously enrolled into this study. The anterior and lateral electronic portal images (EPI) were aquired by EPID once a week. The setup errors were obtained through comparing the difference between EPI and digitally reconstructed radiographs(DRR). Then the setup margins from CTV to PTV were calculat-ed. By using self paired design,22 patients received definitive radiotherapy with different margins. Group A: the margins were 10 mm in all the three axes;Group B: the margins were aquired in this study. The differ-ence were compared by Paired t-test or Wilcoxon signed-rank test. Results The margins from CTV to PTV in x,y and z axes were 8.72 mm, 10.50 mm and 5.62 mm, respectively. Between the group A and group B, the difference of the maximum dose of the spinal cord was significant(4638.7 cGy±1449.6 cGy vs. 4310.2 cGy±1528.7 cGy; t=5.48, P=0.000), and the difference of NTCP for the spinal cord was also significant (4.82%±5.99% vs. 3.64%±4.70%;Z=-2.70,P=0.007). Conclusions For patients with tho-racic esophageal carcinoma who receive 3DCRT in author's department,the margins from CTV to PTV in x, y and z axes were 8.72 mm, 10.50 mm and 5.62 mm, respectively. The spinal cord could be better protected by using these setup margins than using 10 mm in each axis.     

胸段食管癌三维适形放疗摆位误差研究

Objective To study the setup errors in three-dimensional conformal radiotherapy (3DCRT) for thoracic esophageal carcinoma using electronic portal imaging device(EPID) and calculate the margins from CTV to PTV. Methods Forty-one patients with thoracic esophageal carcinoma who received 3DCRT were continuously enrolled into this study. The anterior and lateral electronic portal images (EPI) were aquired by EPID once a week. The setup errors were obtained through comparing the difference between EPI and digitally reconstructed radiographs(DRR). Then the setup margins from CTV to PTV were calculat-ed. By using self paired design,22 patients received definitive radiotherapy with different margins. Group A: the margins were 10 mm in all the three axes;Group B: the margins were aquired in this study. The differ-ence were compared by Paired t-test or Wilcoxon signed-rank test. Results The margins from CTV to PTV in x,y and z axes were 8.72 mm, 10.50 mm and 5.62 mm, respectively. Between the group A and group B, the difference of the maximum dose of the spinal cord was significant(4638.7 cGy±1449.6 cGy vs. 4310.2 cGy±1528.7 cGy; t=5.48, P=0.000), and the difference of NTCP for the spinal cord was also significant (4.82%±5.99% vs. 3.64%±4.70%;Z=-2.70,P=0.007). Conclusions For patients with tho-racic esophageal carcinoma who receive 3DCRT in author's department,the margins from CTV to PTV in x, y and z axes were 8.72 mm, 10.50 mm and 5.62 mm, respectively. The spinal cord could be better protected by using these setup margins than using 10 mm in each axis.