三维适形放疗同步化疗治疗中晚期食管癌的疗效与安全性观察

目的观察三维适形放疗同步化疗治疗中晚期食管癌的疗效与安全性。方法选择67例不能手术的食管癌患者,采用三维适形放射治疗（3D-CRT）同步化疗,化疗先采用DP方案：多西紫杉醇75mg／m^2,第1天;顺铂40mg／m^2,第1、2、3天,21d为一周期,共化疗2个周期,放疗结束后继续化疗4个周期。放疗从第1天开始,DT60-66Gy,分30～33次进行,6～6．5周完成。结果完全缓解39例,部分缓解22例,有效率91．0％;1、2、38局部控制率分别为80．5％、73．1％、46．2％;1、2、3a生存率分别为83．5％、77．6％、52．2％。毒副反应主要为白细胞下降、血小板下降和放射性食管炎,均以Ⅰ-Ⅱ度为主;放射性肺炎发生率较低,且均为Ⅰ-Ⅱ度。结论采用DP方案化疗同步3D-CRT治疗食管癌的近期疗效和局部控制率较好,可以提高患者生存率,虽然毒副反应增加,但患者基本可以耐受。     

老年人食管癌单纯放射治疗的生存率及其影响因素分析

目的探讨单纯放射治疗老年食管癌患者的生存率及其影响因素。方法采用８ＭＶＸ射线体外照射，常规分割，总剂量４９．０～７９．５Ｇｙ，治疗２４０例老年人食管癌，回顾分析单纯放射治疗的疗效，并与文献报道非放射治疗老年人食管癌的疗效进行对照分析。结果全组１、３、５年生存率分别为６０．８％、１５．８％、１０．０％。老年人食管癌的单纯放射治疗疗效与非老年患者相似。病变长度在３～５ｃｍ者预后较好，Ｘ射线分型以蕈伞型预后为好，不同部位病变预后无明显差别。结论对体质尚好、能耐受的老年食管癌患者给予根治量（６０～７０Ｇｙ放射治疗），可获得较好的疗效     

累及野三维适形放射治疗老年人非小细胞肺癌的疗效分析

目的 探讨累及野三维适形放射治疗老年非小细胞肺癌(NSCLC)的临床价值. 方法48例老年NSCLC患者随机分为选择性淋巴引流区照射组(ENI)23例和累及野照射组(IFI)25例,患者年龄60～80岁,中位年龄70岁,均采用三维适形放射治疗技术. 结果 ENl组和IFI组的平均治疗剂量分别为(60.3±3.6)Gy和(66.4±4.7)Gy(t=5.06,P<0.05),有效率分别为48.4%和79.0%(X~2=5.42,P=0.020),ENI组淋巴引流区内复发率为4.3%,IFI组为4.0%(X~2=0.04,P=0.950).Kaplart-Meier分析结果显示,两组中位局部无进展时间分别为14.0个月和18.0个月,1年局部失败率分别为47.8%和32.0%(X~2=1.26,P=0.260);总的中位生存期分别为16.0个月和18.0个月,2年生存率分别为8.7%和28.0%(X~2=2.93,P=0.087).两组治疗相关并发症的发生率差异无统计学意义. 结论对于不能手术的老年NSCLC患者,进行累及野三维适形放射治疗,可以提高疗效.     

三维适形放疗治疗食管癌放疗后复发42例疗效观察

对42例食管癌放疗后复发患者采用三维适形放射治疗,结果近期有效率84％,0．5、1、2、3a的生存率分别为64．3％、52．4％、28,6％、11,9％。提示三维适形放射治疗对食管癌放疗后复发患者有较好的近期疗效,其早期并发症较低,且患者多可耐受。     

食管癌的放射治疗和化学治疗

食管癌有早期扩散和转移的倾向,资料表明即使临床或手术认定为局限性癌肿者(T1～T3,N0～N1,M0)也有40%～75%已发生亚临床转移或邻近器官受累[1-3].单纯手术或放射治疗(放疗)虽可消除局部肿瘤,但复发率甚高,约40%～50%由于肿瘤位置高或瘤体过大不能根治,5年生存率仅6%～10%[2,6].单纯化学治疗(化疗)更有其局限性,不能达到根治目的.因此,以手术为核心的综合治疗是当前食管癌治疗的主流,而放疗和化疗占有重要地位.     

食管癌后程加速超分割三维适形放疗与食管癌后程加速超分割放疗的疗效评价

目的 评价后程加速超分割三维适形放疗与食管癌后程超分割放疗的疗效。方法 将54例食管鳞癌患者前瞻随机分组至后程加速超分割三维适形放疗（LCAH3DCRT）组和后程加速超分割放疗（LCAHRT）组。放疗方法均为前2／3天疗程普通模拟机定位常规放疗40Gy，后1／3疗程LCAH3DCRT组改为CT模拟定位加速超分割三维适形放疗（1．6Gy／次，2次／d，5d／周，20-28Gy），总剂量为60-68Gy，全疗程37-40天；LCAHRT组加速超分割放疗至上述相当剂量。结果 LCAH3DCRT组和LCAHRT组5年生存率分别为31％和22％，LCAH3DCRT组生存率高于LCAHRT组（P=0．028）；3、4、5年无瘤生存率分别为34％、32％、31％和28％、26％、21％，LCAH3DCRT组无瘤生存率均高于LCAHRT组（P值均〈0．05）。LCAH3DCRT组和LCAHRT组1、2、3、4、5年局部控制率分别为78％、73％、61％、59％、56％和58％、37％、30％、28％、25％，LCAH3DCRT组局部控制率高于LCAHRT组（P值均〈0.05）。结论 后程加速超分割三维适形放疗可作为食管癌的首选方法之一，它提高了5年生存率和局部控制率。     

我国食管癌放射治疗的进展

众所周知，食管癌是我国最常见的恶性肿瘤＊一，其死亡率为23．4／10万人．1980年调查，在恶性肿瘤死亡中，仅次于胃癌，排入第二，按性别分时：男性为第二，女性为第三．1996年排列在第四位，我国有些地区，食管癌发病特别高，如河南林县是世界上最高地区，其死亡率比全国平均数高10倍，是美国白人的100倍．食管癌的首选治疗是手术切除，但常常由于病期太晚，或由于内科原因，往往大多数的患者须进行放疗．化疗对食管癌尚无肯定的疗效．中国医学科学院肿瘤医院1958／1986共治疗食管癌9104例，其中单一手术947例（10．4％），术前放疗加手术…     

食管癌CT扫描在放射治疗中的价值

目的研究CF扫描所示肿瘤大小的准确性，依此以肿瘤为射野中心，采用合理的照射野方法1993－12／1996－12病理和CT扫描的食管癌患者77例.取3个层面，绘制并测量相应照射野的大小及正常组织的受量．结果CT所示肿瘤的大小与手术标本比较P＞0．05.放疗组的肿瘤各径线均大于手术组.非对称性浸润，以管腔为射野中心，经典的照射野大小（前宽6．0cm，后斜野5．0cm），≥35．1％的患者90％的等剂量曲线不能包全肿瘤.如以肿瘤为射野中心，前野宽7．0cm，两后斜野为6．0cm，80．7％的患者80％～90％的等剂量曲线包全肿瘤、剂量分布均匀．如肿瘤直径＞5．1cm，先前后对穿野尔后采用分野的照射技术．采用容积-剂量百分比直方图，50％，20％肺最大受量体积分别为18％，49％该剂量临床上很少发生急性放射性肺炎结论证实了食管癌CT扫描的准确性和可靠性，应作为放疗前常规检查方法之一.定位应以肿瘤为中心，确保80％～90％的等剂量曲线包全肿瘤.应据CT所示肿瘤大小，外侵形状，灵活选择照射野.     

后程加速超分割三维适形放射治疗食管癌的临床观察

目的 观察后程加速超分割三维适形放疗(3 DCRT)对食管癌的近远期疗效、不良反应及失败原因.方法 将126例食管鳞癌患者随机分至后程加速超分割三维适形放疗组(后超组)和后程常规分割一维适彤放疗组(对照组).放疗方法 :两组前2/3疗程均为普通模拟机定位常规放疗40Gy,后1/3疗程后超组改为CT模拟定位加速超分割三维适形放疗(1.5Gy/次,24～30Gy,总剂量64～70Gy,36～40次,全疗程38～42 d);对照组常规分割三维适形放疗至上述相当剂量.结果 后超组和对照组5年生存率分别为34%和15%,后超组生存率显著高于对照组(P=0.029).后超组中位复发时间也显著长于对照组(11.0、7.0个月,P<0.01).3、4、5年无瘤生存率分别为36%、34%、32%和19%、16%、15%,后超组无瘤生存率均显著高于对照组(P值均<0.05).后超组和对照组1、2、3、4、5年局部控制率分别为78%、74%、64%、62%、61%和59%、38%、30%、28%、26%.后超组局部控制率均显著高于对照组(P值均<0.05).Cox回归分析显示颈段、胸上段食管癌的疗效明显优于胸中段、胸下段食管癌,蕈伞型优于其他类型(P值均<0.01).结论 常规放疗后进行后程加速超分割三维适形放疗可作为颈段、胸上段和蕈伞型食管癌的首选方法 之一,它可提高局部控制率和远期生存率,且不会明显增加反应.     

三维适形放射治疗老年人前列腺癌34例临床分析

目的分析三维适形放射治疗（3D-CRT）联合内分泌治疗，对老年人前列腺癌的治疗效果。方法回顾性分析本院3D-CRT联合内分泌治疗老年前列腺癌患者34例，29例放射治疗前接受双侧睾丸切除，1例行睾丸放疗去势，4例应用抑那通药物去势。采用3D-CRT技术，1．8～2．0Gy／次，5次／周，D768-72Gy，中位66．7Gy。结果随访时间18个月（4～69个月），3年和5年生存率分别为72．6％和53．7％，5年肿瘤特异生存率为71．8％，1、2、3级急性胃肠道反应发生率分别为52．9％、8．8％和2．9％，1、2级急性泌尿生殖系统反应发生率分别为44．1％和8．8％。结论3D-CRT治疗老年人前列腺癌效果满意，不良反应小。     

食管镜下银夹标记在确定食管癌放射治疗靶区勾画中作用的研究

目的 探讨食管镜下对病变两端进行银夹标记在食管癌适形放射治疗肿瘤靶区确定中的作用.方法 80例初治拟行根治性放射治疗的食管癌患者(早期28例、中晚期52例)通过单纯CT定位、CT定位+X线造影及CT定位+食管镜银夹标记法分别勾画肿瘤大体体积(GTV),比较三种方法下确定的肿瘤靶区长度的差异以及靶区位置在头脚方向(Y轴方向)上的位置差异.结果 早期食管癌患者通过胸部CT、X线造影及食管镜显示的病变长度均值除乳头型外差异有统计学意义(F=4.07～7.43,P＜0.05),乳头型病例三种方法确定的病变长度差异无统计学意义(F=1.71,P＞0.05),单纯CT和CT+X线造影法确定的靶区在Y轴方向上的位置较CT+镜下标记法相差0.5～2.0 cm,三种方法确定的靶区头脚位移差异有统计学意义(F=34.36～193.50,P＜0.01).中晚期食管癌患者通过胸部CT、X线造影及食管镜显示的病变长度均值除菌伞型外差异有统计学意义(F=4.07～30.10,P＜0.05),菌伞型病例三种方法确定的病变长度差异无统计学意义(F=2.44,P＞0,05).三种方法确定的靶区头脚位移差异有统计学意义(F=12.00～21.16,P＜0.01).结论 CT+食管镜银夹标记与单纯CT定位和CT+X线造影法相比,前者对靶区勾画更加敏感、准确.

Abstract：

Objective To study the effect of labeling esophageal carcinoma with sliver clips on two sides by esophagoscopy in mapping the target for conformal radiotherapy (CRT). Methods Eighty patients with esophageal carcinoma (28 patients in early stage, 52 patients in late stage), who were eligible for CRT, were collected and the tumor volume was detected by three methods: CT (A),CT combined with X-ray (B) and CT combined with sliver clip labeling by esophagoscopy (C). The differences of the tumor length and position in head-foot site (Y-axsis) among three methods were compared. Results The comparison of average length of tumor in early stage patients showed significant difference among three methods in all types of tumor (F= 4.07 ～ 7.43, P＜0.05 ) except papillary type (F= 1. 71, P＞0. 05). There was difference (ranged from 0. 5 cm to 2. 0 cm) in detection of position in head-foot site between A and B methods and C method. Significant difference was found in determining the displacement on head-foot site among three methods (F = 34. 36 ～193.50,P ＜0.01). The comparison of average length of tumor in middle or terminal stage patients showed significant difference among three methods in all types of tumor (F=4. 07～30.10 ,P＜0.05) except mushroom type (F = 2.44, P＞ 0. 05). Significant difference was found in determining the displacement on head-foot site among three methods (F= 12.00 ～ 21.16, P ＜ 0. 01 ). Conclusion These findings indicate that C method is more sensitive and correct in mapping the target for CRT in comparison with other two methods.     

Nedaplatin concurrent with three-dimensional conformal radiotherapy for treatment of locally advanced esophageal carcinoma

AIM:To evaluate the efficacy and toxicity of nedaplatin(NDP)concurrent with radiotherapy in the treatment of locally advanced esophageal carcinoma.METHODS:Sixty-eight patients with locally advanced esophageal carcinoma were randomized into either a NDP group(n=34)or a cisplatin(DDP)group(n=34).The NDP group received NDP 80-100 mg/m2iv on day 1+leucovorin(CF)100 mg/m2iv on days 1-5+5-fluorouracil(5-FU)500 mg/m2iv on days 1-5.The DDP group received DDP 30 mg/m2iv on days 1-3+CF 100 mg/m2on days 1-5+5-FU 500 mg/m2iv on days 1-5.The treatment was repeated every 4 wk in both groups.Concurrent radiotherapy[60-66 Gy/(30-33f)/(6-7 wk)]was given during chemotherapy.RESULTS:There was no significant difference in the short-term response rate between the NDP group and DDP group(90.9%vs 81.3%,P=0.528).Although the 1-and 2-year survival rates were higher in the NDP group than in the DDP group(75.8%vs 68.8%,57.6%vs 50.0%),the difference in the overall survival rate was not statistically significant between the two groups(P=0.540).The incidences of nausea,vomiting and nephrotoxicity were significantly lower in the NDP group than in the DDP group(17.6%vs 50.0%,P=0.031;11.8%vs 47.1%,P=0.016;8.8%vs 38.2%,P=0.039).There was no significant difference in the incidence of myelosuppression,radiation-induced esophagitis or radiation-induced pneumonia between the two groups.CONCLUSION:NDP-based concurrent chemoradiotherapy is effective and well-tolerated in patients with locally advanced esophageal carcinoma.NDP-based regimen has comparable efficacy to DDP-based regimen but is associated with lower incidences of gastrointestinal and renal toxicity.     

老年人晚期胰腺癌立体定向放射治疗的临床研究

目的 探讨老年人晚期胰腺癌立体定向放射治疗的近期疗效。方法 对我院采用立体定向伽玛射线放射治疗的65例老年晚期胰腺癌患者的临床资料及随访情况进行回顾性分析。结果 放射治疗后疼痛缓解或消失53例(92．9％)，体重增加≥7％者19例(29．2％)，卡氏评分较入组前上升超过20分以上者28例(43．1％)，临床受益反应率为61．2％；完全缓解(CR)4例(7．0％)，部分缓解(PR)21例(36．8％)，CR PR为25例(43．8％)。中位生存时间9．3个月。结论 老年人晚期胰腺癌的立体定向伽玛射线放射治疗近期疗效显著，是一种安全、可靠的治疗方法。     

食管癌放射治疗85例

目的:探讨食管癌放射治疗的疗效及其影响预后的相关因素.方法:收集2004-04/2009-04采用非手术综合治疗的食管癌患者85例进行预后分析,探讨影响预后的临床因素.生存率采用Kaplan-Meier法进行计算,并采用对数秩和检验(Log-rank test法)进行单因素分析,采用Cox比例风险模型对可能影响其预后的因素进行多因素回归分析.结果:随访率100%,1、3年生存率分别为65.9%、29.4%.单因素分析影响食管癌预后的因素有年龄、病变部位、病变长度、临床分期、治疗方式、放疗技术和近期疗效,而性别、放疗剂量大小与预后无关.Cox比例风险回归模型进行多因素分析显示治疗方式、临床分期和近期疗效为影响预后的独立因素.结论:食管癌放疗后总体生存率仍然较低,治疗方式、临床分期和近期疗效是影响食管癌预后的主要因素.     

食管镜下银夹标记在确定食管癌放射治疗靶区勾画中作用的研究

Objective To study the effect of labeling esophageal carcinoma with sliver clips on two sides by esophagoscopy in mapping the target for conformal radiotherapy (CRT). Methods Eighty patients with esophageal carcinoma (28 patients in early stage, 52 patients in late stage), who were eligible for CRT, were collected and the tumor volume was detected by three methods: CT (A),CT combined with X-ray (B) and CT combined with sliver clip labeling by esophagoscopy (C). The differences of the tumor length and position in head-foot site (Y-axsis) among three methods were compared. Results The comparison of average length of tumor in early stage patients showed significant difference among three methods in all types of tumor (F= 4.07 ～ 7.43, P＜0.05 ) except papillary type (F= 1. 71, P＞0. 05). There was difference (ranged from 0. 5 cm to 2. 0 cm) in detection of position in head-foot site between A and B methods and C method. Significant difference was found in determining the displacement on head-foot site among three methods (F = 34. 36 ～193.50,P ＜0.01). The comparison of average length of tumor in middle or terminal stage patients showed significant difference among three methods in all types of tumor (F=4. 07～30.10 ,P＜0.05) except mushroom type (F = 2.44, P＞ 0. 05). Significant difference was found in determining the displacement on head-foot site among three methods (F= 12.00 ～ 21.16, P ＜ 0. 01 ). Conclusion These findings indicate that C method is more sensitive and correct in mapping the target for CRT in comparison with other two methods.     

Serum transforming growth factor-β1 level reflects disease status in patients with esophageal carcinoma after radiotherapy

AIM: To evaluate the relationship between changes in serum transforming growth factor β1 (TGFβ1) level and curative effect of radiotherapy (RT) in patients with esophageal carcinoma.METHODS: Ninety patients with histologically confirmed esophageal carcinoma were enrolled. Serum samples for TGFβ1 analysis were obtained before and at the end of RT. An enzyme-linked immunosorbent assay was used to measure serum TGFβ1 level. Multivariate analysis was performed to investigate the relationship between disease status and changes in serum TGFβ1 level.RESULTS: Serum TGFβ1 level in patients with esophageal carcinoma before RT was significantly higher than that in healthy controls (P ＜ 0.001). At the end of RT, serum TGFβ1 level was decreased in 67.82% (59/87) of the patients. The overall survival rate at 1,3 and 5 years was 48.28% (42/87), 19.54% (17/87)and 12.64% (11/87), respectively. Main causes of death were local failure and regional lymph node metastasis.In patients whose serum TGFβ1 level decreased after RT,the survival rate at 1, 3 and 5 years was 61.02% (36/59),28.81% (17/59) and 18.64% (11/59), respectively. The survival rate at 1 year was 17.86% (5/28) in patients whose serum TGFβ1 level increased after RT, and all died within 18 mo (P ＜ 0.01).CONCLUSION: Serum TGFβ1 level may be a useful marker for monitoring disease status after RT in patients with esophageal carcinoma.