前程加速超分割放射治疗食管癌疗效分析

目的 :评价前程加速超分割治疗食管癌放疗疗效及放射反应。方法 :对 96例食管癌随机分为前程加速超分割组 (前超组 )和常规组 ,每组 4 8例 ,全部经病理证实。男性 6 3例 ,女性 33例 ;年龄 4 1岁～ 70岁 ,中位年龄 5 7岁 ;病变部位胸上段 2 1例 ,胸中段 6 3例 ,胸下段 12例。病变长度 :<5cm 2 9例 ,5 0cm～ 7 0cm 5 7例 ,>10cm 10例。全部采用 6MVX线外照射 ,常规组 1次 /天 ,2 0Gy/次 ,5次 /周 ,总剂量 6 4Gy～ 6 8Gy ,4 4～ 4 5天完成。前超组 2次 /天 ,1 5Gy/次 ,间隔 6小时以上 ,总剂量 6 4～ 6 8Gy ,35～ 37天完成。 结果 :随访率 96 9%。 1、3、5年生存率前超组为 81 15 %、4 4 1%和 2 6 8% ,常规组为6 1 7%、2 5 1%和 16 9%。前超组 1、3年生存率高于常规组 (u值为 2 97及 2 6 4 ,P <0 0 1) ,5年生存率无显著意义 (u =1 71,P >0 0 5 )。前超组和常规组放射性食管炎发生率分别为 2 7 16和 16 7% (χ2 =1 5 2 ,P =0 2 0 ) ;放射性气管炎发生率前超组为 18 8% ,常规组为 12 5 % (χ2 =0 71,P =0 4 0 )。结论 :食管癌前程加速超分割治疗的 1年和 3年生存率高于常规组 ,5年生存率无明显差异 ,患者对前超组放疗副作用与常规组相比无明显增加。     

后程加速超分割放射治疗及其辅加化疗对中晚期食管癌的疗效对比观察

目的比较单纯后程加速超分割放射治疗及后程加速超分割放射治疗辅加化疗治疗食管癌的疗效与毒副反应。方法将162例食管癌患者随机分为2个组：①后程加速超分割放疗组（简称单放组，LCAFR），80例。治疗方案：常规分割30Gy＋加速超分割（1．5Gy/次，2次／天，间隔≥6h），总剂量为63Gy；②后程加速超分割放疗辅加化疗组（简称综合组，LCAFR＋C），82例。治疗方案：在后程加速超分割放疗（LCAFR）的同期加用顺铂（DDP）20mg、氟脲嘧啶（5-Fu）500mg、亚叶酸钙（CF）0、2g，连用5天为1个周期，分别在第1、4周实施，共2个周期。结果单放组和综合组的1、2、3年生存率分别为53．8％（43／80）、35．O％（28／80）、25．0％（20／80）和79．3％（65／82）、54．8％（45／82）、43．9％（36／82），2组有显著性差异（X^2=10．33，P〈0．01；X^2=5．61，P〈0．05；X^2=5．65，P〈0．05）。2组患者的死亡原因均以肿瘤局部未控制和复发为主。综合组因肿瘤局部未控制和复发的死亡率（50．0％，18／36）明显低于单放组（75．0％，45／60），2组比较有显著性差异（X^2=6．18，P〈0．05）。2组治疗的急性毒副反应以消化系统及造血系统毒副反应为主，综合组急性毒副反应发生率Ⅲ度消化系统为（18．3％，15／82）高于单放组，但无显著性差异。结论后程加速超分割放射治疗辅加化疗能显著提高食管癌患者的3年生存率，虽毒性增加但可以耐受。     

后程加速超分割放射治疗晚期鼻咽癌的疗效观察

目的探讨后程加速超分割放射治疗晚期鼻咽癌的临床疗效,同时观察急性放疗反应和后遗症。方法92例Ⅲ、Ⅳa期鼻咽癌患者随机分为常规分割放射治疗组(常规组)46例和后程加速超分割放射治疗组(后超组)46例,常规组2.0G y/次,1次/d,5次/周,总剂量(74￣78)G y/(7.4￣7.8)周,后超组前3.5￣4周照射同常规组,放疗至36￣40G y后改为1.5G y/次,2次/d,间隔6￣8h,5d/周,总剂量(72￣78)G y/(7.2￣7.8)周。结果两组病例3年鼻咽原发灶控制率分别为69.6%和87.0%,差异有显著性意义(P<0.05),3年生存率分别为67.4%、76.1%,差异无显著性意义(P>0.05),3年累积远处转移发生率分别为32.6%和26.1%,差异无显著性意义(P>0.05)。两组颈淋巴结控制率相仿;两组急性黏膜放射反应和正常组织后期放射反应相仿。结论后程加速超分割放射治疗较常规分割放射治疗提高了Ⅲ、Ⅳa期鼻咽癌3年鼻咽原发灶控制率,不能提高3年生存率,两组急性放射反应相似,后期放射反应相仿,有必要扩大病例并作长期随访研究。     

后程加速超分割适形放疗联合顺铂化疗食道癌的近期疗效观察

目的:观察食道癌后程加速超分割适形放疗联合顺铂化疗的疗效.方法:对174例食道癌患者随机分为后程加速超分割适形放疗联合顺铂组(后程加速超分割联合顺铂组)和常规适形放疗组,每组87例,全部经病理证实为鳞癌.全部采用6MV-X外照射,常规分割适形放疗组1次/d,2Gy/次,总剂量60～70Gy/6～7w,后程加速超分割适形放疗联合顺铂化疗组在常规照射40Gy后,改为每日两次,每次剂量1.35～1.4Gy,间隔6h以上,化疗于放疗开始每周六应用,用顺铂30mg/m2静脉滴注.结果:后程加速超分割联合顺铂化疗组近期疗效明显优于常规适形放疗组.结论:食道癌后程加速超分割适形放疗联合顺铂组能提高食道癌患者的治疗效果、明显改善病人生存质量,患者对后程加速超分割适形放疗联合顺铂化疗耐受性可.     

后程加速超分割放疗加同步化疗治疗晚期下咽低分化癌的临床观察

目的比较晚期下咽低分化或未分化癌患者通过常规放射治疗、后程加速超分割放疗加和不加同步化疗的近期疗效和副反应。方法72例晚期低分化或未分化下咽癌患者随机分为三组,即常规放疗(CIR)组、后程加速超分割(AH-FR)组和后程加速超分割加同步化疗(AHFR CC)组。结果三组在放疗半量(36Gy)时下咽病灶有效(PR CR)率分别为54·2%、54·2%和70·8%;颈部转移灶有效(PR CR)率分别为54·2%、54·2%和70·8%;全量放疗结束时下咽病灶完全消退(CR)率分别为66·7%、83·3%和87·5%,CIR组与AHFR CC组比较无明显差异性(P>0·05);颈部转移灶完全消退(CR)率分别为70·8%、83·3%和91·7%,CIR组与AHFR CC组比较无明显差异性(P>0·05);放化疗毒副作用所致恶心呕吐和骨髓抑制等差异有显著性(P<0·05)。结论晚期下咽低分化或未分化癌后程加速超分割放疗加同步化疗较单纯常规放疗疗效好,但毒副作用较重。     

后程加速超分割放疗食管中段癌临床Ⅲ期试验

目的采用前瞻随机性研究，探讨后程加速超分割放疗（late course accelerated hyperfractionation radiotherapy，LCAHR）能否提高食管中段癌疗效。方法将104例食管中段癌经分层随机分加速超分割治疗组（E组）51例，常规治疗组（C组）53例，两组患者一般临床资料差异无统计学意义。放射总剂量E组：（65．6±1．9）Gy，照射36（34～38）次／38（36—47）d；C组：总剂量（66．0±1．3）Gv，照射33（32—34）次／45（43～50）d。结果急性放射性食管炎E组88％，C组72％（P=0．015）。E组在不同随访期有2例死于食管大出血，1例出现放射性肺炎。1，2，3年局控率E组为78％、57％、43％而C组为58％、36％、26％（P＝0．047）；1、2、3年生存率E组为75％、51％、41％，而C组为56％、36％、23％（P=0．042）。结论后程加速超分割放疗能为患者耐受提高了局控及生存率。     

食管癌后程加速超分割放疗配合化疗及丹参的疗效观察

目的 探讨食管癌后程加速超分割放疗配合化疗及丹参的疗效.方法 将60例确诊的食管癌患者随机分为两组,后程加速超分割放疗配合化疗及丹参组(简称后超组)和常规分割放疗组(简称常规组),观察两组治疗效果及毒副作用.结果 后超组1,2,3年局部控制率及生存率均好于常规组(P＜0.05).白细胞下降、胃肠道反应及放射性肺炎等两组比较无显著差异(P＞0.05).结论 食管癌后程加速超分割放疗配合化疗及丹参疗效确切,且毒副反应可接受,值得临床推广应用.     

Accelerated hyperfractionation (AHF) compared to conventional fractionation (CF) in the postoperative radiotherapy of locally advanced head and neck cancer: influence of proliferation

Based on the assumption that an accelerated proliferation process prevails in tumour cell residues after surgery, the possibility that treatment acceleration would offer a therapeutic advantage in postoperative radiotherapy of locally advanced head and neck cancer was investigated. The value of T(pot) in predicting the treatment outcome and in selecting patients for accelerated fractionation was tested. Seventy patients with (T2/N1-N2) or (T3-4/any N) squamous cell carcinoma of the oral cavity, larynx and hypopharynx who underwent radical surgery, were randomized to either (a) accelerated hyperfractionation: 46.2 Gy per 12 days, 1.4 Gy per fraction, three fractions per day with 6 h interfraction interval, treating 6 days per week or (b) Conventional fractionation: 60 Gy per 6 weeks, 2 Gy per fraction, treating 5 days per week. The 3-year locoregional control rate was significantly better in the accelerated hyperfractionation (88 +/- 4%) than in the CF (57+/- 9%) group, P=0.01 (and this was confirmed by multivariate analysis), but the difference in survival (60 +/- 10% vs 46 +/- 9%) was not significant (P=0.29). The favourable influence of a short treatment time was further substantiated by demonstrating the importance of the gap between surgery and radiotherapy and the overall treatment time between surgery and end of radiotherapy. Early mucositis progressed more rapidly and was more severe in the accelerated hyperfractionation group; reflecting a faster rate of dose accumulation. Xerostomia was experienced by all patients with a tendency to be more severe after accelerated hyperfractionation. Fibrosis and oedema also tended to be more frequent after accelerated hyperfractionation and probably represent consequential reactions. T(pot) showed a correlation with disease-free survival in a univariate analysis but did not prove to be an independent factor. Moreover, the use of the minimum and corrected P-values did not identify a significant cut-off. Compared to conventional fractionation, accelerated hyperfractionation did not seem to offer a survival advantage in fast tumours though a better local control rate was noted. This limits the use of T(pot) as a guide for selecting patients for accelerated hyperfractionation. For slowly growing tumours, tumour control and survival probabilities were not significantly different in the conventional fractionation and accelerated hyperfractionation groups. A rapid tumour growth was associated with a higher risk of distant metastases (P=0.01). In conclusion, tumour cell repopulation seems to be an important determinant of postoperative radiotherapy of locally advanced head and neck cancer despite lack of a definite association between T(pot) and treatment outcome. In fast growing tumours accelerated hyperfractionation provided an improved local control but without a survival advantage. To gain a full benefit from treatment acceleration, the surgery-radiotherapy gap and the overall treatment time should not exceed 6 and 10 weeks respectively.     

营养支持对64例食管癌患者放射治疗结局的影响

目的评估营养支持对超分割放射治疗食管癌患者预后的影响。方法将1995年7月至2000年5月在我院接受超分割放射治疗的64例食管癌患者随机分为支持组和对照组，每组32人。支持组患者按照营养医师指导进食，对照组患者随意进食。结果两组患者的营养素、热能及生化检测指标在支持前后差异均有显著性（P均〈0．05）。支持组患者1年营养不良率为26．9％，显著低于对照组的61．1％（P〈0．05），2、3年营养不良率为52．4％和58．8％，也低于对照组的69．2％和77．7％。支持组患者的1、2、3年生存率分别为81．3％、65．6％和53．1％．明显高于对照组的56．3％、40．6％和28．1％（P〈0．05）。结论营养支持能明显改善超分割放射治疗后食管癌患者的营养状态，提高其生存率。     

Concurrent Accelerated Hyperfractionated Radiation Therapy and Carboplatin/etoposide in Patients With Malignant Glioma: Long-term break Results of A Phase II Study

Purpose: Feasibility, antitumor activity and toxicity of accelerated hyperfractionated radiation therapy (Acc Hfx RT) and concurrent carboplatin/etoposide (CBDCA/VP 16) chemotherapy were investigated in patients with malignant glioma. Material and methods: Seventy-nine patients with either glioblastoma multiforme (GBM) (n = 61) or anaplastic astrocytome (AA) (n = 18) entered into a phase II study on the use of Acc Hfx RT with 60Gy in 40 fractions in 20 treatment days over 4 weeks and concurrent CBDCA, 200mg/m², and VP 16, 200mg/m², both given once weekly during the RT course. Results: The median survival time for all 79 patients was 14 months (11 and 44 months for GBM and AA patients, respectively), while the 2- and 4-year survival was respectively 33% and 11% for all patients, 13% and 1.6% for GBM patients, and 100% and 44% for AA patients (p < 0.0001). The median time to progression for all patients was 12 months (9 and 40 months for GBM and AA, respectively), while the 2- and 4-year progression-free survival (PFS) was respectively 28% and 10% (all patients), 10% and 1.7% (GBM) and 89% and 39% (AA) (p < 0.0001). Multivariate analysis showed that age, performance status, and preoperative size of tumor influenced survival in GBM. Only 5 (6%) patients experienced grade 3 leukopenia and 6 (8%) patients experienced grade 3 thrombocytopenia. No late RT-induced toxicity was observed to date. Conclusions: Although Acc Hfx RT/CBDCA + VP 16 was feasible and little toxic, it failed to improve survival/progression-free survival over that obtained with other currently used regimens. These results do not justify the investigation of this regimen in a phase III trial.