Results of radiotherapy for inoperable locally advanced esophageal cancer

Three hundred and eleven patients with locally advanced esophageal cancer were treated by radiation therapy from 1968 to 1983 at Tokyo Women's Medical College. Of these, 288 patients with previously untreated, histologically confirmed squamous cell carcinoma but previously treated with curative intent, were eligible for analysis. The cumulative 5-year survival rate of 288 patients given radical radiotherapy was 9.0%. Sex, tumor length, and Stage (AJC) had a great influence on prognosis. The five-year survival rate in males was 5.4% and in females was 22.4%. The five-year survival rate in cases with a tumor length of 5 cm or less was 17.7% in 5-10 cm was 10.0%, and in 10 cm or above was 2.8% and they were 20.2% for Stage I, 9.9% for Stage II, and 2.6% for Stage III. There were no significant differences of survival rate among age, tumor site, and tumor type on X ray film. This data suggests that comparatively early, small-volume tumors share a significant potential for cure by radiotherapy, but potent combined therapy is necessary for the treatment of advanced cancers.     

食管癌放射治疗非常规分次方案的剂量—效应分析

目的：对近年国内报道的食管癌非常规分次方案剂量－效应分析，探索改善放射治疗疗效较合理的方法，方法：收集1989年以来食管癌非常规分次（ICF）照射和以常规剂量分次（CF）作为对照的前瞻性随机分组结果，比较肿瘤局部控制率或（及）生存率。依LQ模式计算各个方案对肿瘤组织的放射生物学效应剂量（BEDT）值，与各自的CF对照组进行剂量－效应比较。结果：超分割（HF）3个组中2个组疗效显著提高。其BEDT值降低17．2Gy；疗效无差异1个组BEDT值降低6．8Gy。加速超分割（AHF）2个组中1个组BEDT值降低17．2Gy，疗效无差异；1个组疗效显著提高不能用BEDT值降低11．3Gy来解释，后程加速超分割（LAHF）的7个组中，疗效显著提高的有6个组，其BEDT值比较不能用于预测LAHF对CF方案的疗效差别。后程加速分割（LAF）1个组BEDT值仅高出2．8Gy，但1、3年生存率提高非常显著。前程加速分割（EAF）1个组的已知疗效完全缓解率提高的相关因素是剂量高6．8Gy。结论（1）用ICF方案有可能在肿瘤局部控制率、生存率方面显著高于CF60－70Gy，6－7周方案者。（2）AHF、LAHF和LAF的疗效显著提高不能用该方案的BEDT值来解释和预测，疗效的显著改善不依赖于剂量的增加。（3）照射后使肿瘤细胞集群对放射杀灭再敏感化。（4）LAF能提高治疗获得（TG），是一些ICF方案治疗效应提高的放射生物学基础。     

不均等剂量放射治疗食管癌远期疗效

目的 探讨不均等剂量放射治疗食管癌的可行性。方法 160例食管鳞癌患者,信封法随机分为不均等剂量组80例,常规剂量组80例。入组者需无明显食管龛影及穿孔征象。两组均采用模拟机定位,体外3个野照射。不均等剂量组4Gy／次,5d／周,第2周开始2Gy／次,5d／周,共70Gy6周。常规剂量组2Gy／次,5d／周,共70Gy。结果 全部病例随访5年以上。局部控制率不均等剂量组和常规剂量组分别为46．3％、27．5％（X^2SS=6.150,P=0.022)。1、3、5年生存率不均等剂量组分别为72．5％、38．8％、31．3％,常规剂量组分别为57．5％、23．8％、16．3％（X^2=4.187,P=0.043,X^2;5.141,P=0.037;X^2=5.452,P=0.032)。晚期放射损伤（肺纤维化、食管狭窄、食管溃疡）发生率低、两组无明显差异。结论 前程加大放射治疗剂量,短时期内大量杀灭肿瘤敏感细胞,提高了局部性控制率和远期生存率,并且不增加副反应。不均等剂量放射治疗食管癌优于常规剂量,是目前可行的一种新的放射治疗方法。     

食管癌的精确放射治疗

三维适形放疗能提高食管癌放疗的适形性和减少正常组织的照射剂量.所以,笔者在本文中探讨了如何勾画靶区,以及如何在限制肺和心脏等正常组织剂量的同时使得靶区受到较好的剂量分布.     

食管癌精确放疗的研究进展

目的:总结食管癌精确放疗的国内外研究进展,为临床治疗提供依据.方法:应用PubMed和CNKI等数据检索系统及数据库,以“食管癌、放射治疗”等为关键词检索2000-01-2011-10的相关文献,纳入标准:1)四维CT、正电子发射计算机/断层显像(PET/CT)在食管癌精确放疗中的应用及靶区勾画研究进展;2)不同食管癌精确放疗计划的剂量学比较;3)食管癌精确放疗的分割方式及疗效评估.根据纳入标准分析文献36篇.结果:四维CT及PET/CT在食管癌精确定位及靶区勾画中得到很好的应用,三维适形放疗/调强化疗(3DCRT/IMRT)治疗提高了食管癌患者的局部控制率及近期生存率.Rapid Arc具有靶区剂量适形度高,剂量分布均匀性好,减少总机器跳数和减少治疗时间等优势.改变放疗方式利用3DCRT后程加速超分割比常规分割疗效略有提高,但急性放疗反应加重,晚期反应的发生率未增加.结论:食管癌精确放疗仍以3DCRT/IMRT为主,Rapid Arc技术虽然有较好的优越性,但是临床应用前景需要进一步研究.     

Combined radiotherapy for inoperable esophageal cancer

Among 112 patients with inoperable esophageal cancer treated with high-dose intraluminal brachytherapy and distant irradiation, objective response was in 84.8%. Predominantly local complications were reported in 78.6%. Recurrences were detected in 63.5% during follow-up, with mean relapse-free period being 107 days. Mean survival time was 15.3 months (1-, 2- and 3-year survival--58.8; 22.3 and 12.9%, respectively) which was comparable to similar results of palliative esophagectomy for gastric cancer.     

食管癌再程放疗的临床观察

目的探讨食管癌放疗后局部复发再程放疗的治疗价值,并分析再程放疗及放疗联合化疗的疗效和不良反应。方法采用回顾性分析方法,对开封市中心医院2005-05-18-2010-05-21收治的41例食管癌患者,分为单纯再程放疗组20例及化疗联合再程放疗组21例,对其疗效、不良反应等进行比较。结果单纯再程放疗组有效率(RR)为45.00%(9/20),化疗联合再程放疗组为85.71%(18/21),差异有统计学意义,χ2=8.25,P=0.035。单纯再程放疗组1年生存率为45.00%(9/20),2年为25.00%(5/20),3年为10.00%(2/20);化疗联合再程放疗组1年生存率为52.38%(11/21),2年为28.57%(6/21),3年为14.29%(3/21);2组差异无统计学意义,χ2=0.05,P=0.975。单纯再程放疗组急性放射性食管炎发生率为75.00%(15/20),≥2级者为45.00%(9/20);化疗联合再程放疗组则分别为90.45%(19/21)和52.39%(11/21);2组差异无统计学意义,z=-0.877,P=0.380。单纯再程放疗组急性放射性肺炎发生率为20.00%(4/20),≥2级者为5.00%(1/20);化疗联合再程放疗组分别为23.81%(5/21)和9.52%(2/21);2组差异无统计学意义,z=-0.361,P=0.718。单纯再程放疗组骨髓抑制发生率为45.00%(9/20),≥2级者为5.00%(1/20);化疗联合再程放疗组分别为57.14%(12/21)和23.81%(5/21);2组差异无统计学意义,z=-1.228,P=0.220。结论食管癌放疗后局部复发再程放疗仍是有效治疗的手段,联合化疗是可行的,并能提高治疗效果,不良反应可耐受。     

食管癌的放射治疗进展

食管癌放射治疗采用三维适形放疗(three dimensional conformal radiotherapy,3D-CRT)/调强放疗(intensity-modulated radiation tlaerapy,IMRT)已经10余年,但疗效并无突破性进展.是否需要进行淋巴结预防照射是目前讨论较多的问题.复旦大学肿瘤医院采用的方法是:临床靶体积(clinical targetvolume,CTV)=大体肿瘤体积(gross tumor volume,GTV)+上、下3 cm正常食管,计划靶体积(planning targetvolume,PTV)=CTV外放1 cm,并不进行淋巴结预防照射.PET/CT检查是早期评估食管癌放化疗疗效的有益手段,PET/CT有效的患者可能可以避免没有必要的手术,从而保留食管.靶向药物联合放化疗是目前的热点方向,EGFR拮抗剂体现了初步的疗效,多个随机分组试验正在进行中.     

IGRT在颈段、胸上段食管癌放疗中的应用

目的:应用kV-CBCT技术分析颈段、胸上段放疗时的摆位误差,并对其最佳配准方式和CTV-PTV外放间距进行初步探讨。方法:对11例接受3DCRT或IMRT的颈段、胸上段食管癌患者进行每周1-2次kV-CBCT扫描,分别按手动配准、骨性配准和灰度配准进行匹配,比较三种配准方式的差异,分析摆位误差,计算并比较校位前后CTV-PTV的外放间距。结果:手动、骨性和灰度配准在X轴、Y轴、Z轴的平移误差分别为(0.04±0.34)cm/(0.06±0.36)cm/(-0.02±0.29)cm、(-0.11±0.53)cm/(-0.10±0.53)cm/(0.04±0.55)cm、(0.08±0.16)cm/(0.06±0.21)cm/(-0.03±0.26)cm,三种配准方式结果均显示Y轴平移误差最大,其次为Z轴,X轴的最小;骨性配准和手动配准结果较为相近(P>0.05),灰度配准的误差值均明显小于以上两者(P<0.05);手动、骨性和灰度配准在X轴、Y轴、Z轴的旋转误差分别为(1.21±1.07)°/(1.20±1.06)°/(1.33±1.11)°、(-0.11±0.53)°/(-0.10±0.53)°/(0.04±0.55)°、(0.08±0.16)°/(0.06±0.21)°/(-0.03±0.26)°,三种配准方式结果均显示X轴旋转最大,其次为Z轴,Y轴最小,三种配准方式间无明显差异(P<0.05);骨性配准任一方向平移误差>0.3cm者,校位前X轴、Y轴、Z轴的平移误差分别为0.05±0.31cm、0.19±0.42cm、-0.06±0.37cm,校位后分别缩小至0.01±0.16cm、0.08±0.17cm、0.03±0.12cm,(P<0.05);校位前X轴、Y轴、Z轴CTV-PTV外放间距分别为0.29cm、1.03cm、0.60cm,校位后缩小至0.09 cm、0.23 cm、0.16 cm,(P<0.05)。结论:本组颈段、胸上段食管癌病例放疗时以Y轴平移误差最为明显,应用kV-CBCT实施IGRT可缩小摆位误差及CTV-PTV外放间距,配准方式以骨性配准为首选,必要时进行手动微调。     

放疗同期多西紫杉醇和顺铂化疗不能手术食管癌的疗效观察

毒副反应主要表现为骨髓抑制,特别是白细胞减少和中性粒细胞减少,非血液学毒性轻微.11例患者治疗后出现胸腔积液,对症处理后好转.结论 放疗同期多西紫杉醇和顺铂治疗不能手术食管癌的局部控制高,骨髓抑制在G-CSF的支持下查以耐受.     

Combination of radiotherapy with cisplatin in esophageal cancer

Combination of radiotherapy with Cisplatin was performed in order to improve the results obtained with radiotherapy alone in the treatment of esophageal cancer. The therapeutic effect of this regimen and administration of Cisplatin were analyzed in 7 primary and 8 recurrent esophageal cancer patients from April 1983 to February 1985 in N.I.R.S. Cisplatin 10 mg/m2, without hydration and diuresis, was given daily followed by radiotherapy of 2 Gy daily for five consecutive days. The course was performed for two consecutive weeks and repeated after a one-week withdrawal of Cisplatin alone. Total doses of Cisplatin were 200 mg and the total dosage of radiotherapy including fast neutrons was TDF 110 to 120. Cisplatin 30 to 50 mg/m2 was continued monthly for maintenance every four weeks after the second course. Response rates in primary and recurrent cases were 71.4% and 62.5% respectively. Administration of Cisplatin 10 mg/m2 daily was useful since nausea and vomiting rarely appeared and bone marrow toxicity and renal dysfunction as side effects were mild and reversible. In the combination of radiotherapy with Cisplatin, it seemed most effective to perform radiotherapy immediately after Cisplatin administration, considering the change in serum concentration.     

42例放疗后复发食管癌三维适形放疗的疗效分析

目的 探讨三维适形放疗(3DCRT)在食管癌首程放疗后局部复发患者中应用的可行性、疗效和放射损伤及影响因素.方法 42例首程放疗后局部复发的食管癌患者,采用3DCRT技术进行二程放疗.放疗处方剂量中位值54 Gy(50～64 Gy),1.8～2.0 Gy/次,5次/周.结果 随访截至2008年12月31日,随访率为100%,其中随访满1、2年者分别为20、22例.42例患者中完全缓解7例,部分缓解31例,无进展4例.全组患者1、2年总生存率分别为60%和24%.全组≥2级放射性食管炎15例,其中2级13例,3级2例.≥2级放射性肺炎9例,其中2级8例,3级1例.≥2级血液学副反应3例,其中2级2例,3级1例.本组共死亡28例,其中死于局部复发9例、远处转移7例、食管瘘1例、食管狭窄1例、全身衰竭4例、心脏病3例、电解质紊乱1例、死因不明1例.结论 食管癌首程放疗后局部复发采用3DCRT二程放疗是可行的,有较好临床症状缓解率和即时疗效,部分患者可延长生存期;但再程放疗并发症较高,临床应用时应严格掌握其适应证.     

Combined radiotherapy and chemotherapy for the treatment of esophageal cancer

Eight patients with esophageal cancer were treated by a new treatment schedule consisting of low dose irradiation, crescendo cisplatin and bleomycin polyacrylate pasta. As monitored endoscopically, therapeutic responses were satisfactory: seven out of 8 patients have survived for a range of 3 to 20 months and still active at work or cancer-free. However, one patient suffered from a second malignancy of adenocarcinoma of the upper esophagus different from the initial squamous cell carcinoma at the lower esophagus which had successfully been treated 3 months before. The present therapeutic design aims at treatment of lymphatic spreads in the adjacent structures as well as the original tumor in the esophagus and submucosal invasions. It is basically a consecutive, multimodal integration of selective concentration of therapeutic effects (extensive radiotherapy, topical application of bleomycin polyacrylate pasta, lymphatic chasing with colloidal bleomycin, and spatial concentration of cisplatin as the result of radiation-induced inflammation), perpetuation of the repairable DNA damage, and biological amplifications (protection against esophageal perforation with polyacrylate coating, and specific cancer cell recruitment). Application of the present therapeutic design is being expanded to the treatment of cancer of other specific sites such as the head and neck tumors and rectal cancer with undeniable prospects.     

食管癌放射治疗技术的选择与应用

放射治疗是食管癌的根治性手段之一。随着医学影像学、计算机技术及放射物理学的快速发展,放疗技术取得了革命性的进步,从常规放疗迈进精确放疗时代。现综述放射治疗技术在食管癌放疗中的选择和应用,主要包括常规放射治疗、 X刀、γ刀、三维适形放疗、调强适形放疗、图像引导调强放疗、容积弧形调强放射治疗、自适应放疗及内照射后装治疗等。     

食管癌放疗中食管损伤的相关因素分析

急性放射性食管损伤是食管癌放疗的剂量限制因素之一.我们对52例食管癌三维适形放疗(3D-CRT)患者的资料进行回顾性分析,观察相关因素与急性放射性食管损伤之间的关系.