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.

Late course accelerated three-dimensional conformal radiotherapy for esophageal carcinoma

Objective To investigate the result and side effect of late course accelerated three-di-mensional conformal radiotherapy (3DCRT) for esophageal carcinoma. Methods From July 2003 to March 2006, 55 patients with esophageal carcinoma receiving 3DCRT were randomly divided into late course accel-erated radiation group (group A, 27 patients) and conventional fractionation group (group B, 28 patients). The prescribed dose in group B was 64 -66 Gy, 2 Gy per fraction, 1 fraction per day, 5 fractions per week for about 6.5 weeks. Patients in group A received conventional fractionation irradiation for the first 4 weeks. Then the dose was increased to 3 Gy per fraction to a total dose of 67 -70 Gy. The treatment course in group A was about 6 weeks. The treatment response, acute site effects, 1-, 3-and 5-year local control rates and o-verall survival rates of the two groups were observed. Results In group A, 23 patients (85%) achievedcomplete response (CR) and 4(15%) achieved partial response (PR). While in group B, 16 patients (57%) achieved CR and 12(43%) achieved PR. The CR rate was significant higher in group A (χ~2 = 5.24,P=0.022). The 1-, 3-, 5-year local control rates were 85%, 54%, 54% in group A, and 70%, 56%, 33 % in group B (χ~2 = 0.68, P = 0.409), respectively. The 1 -,3-,5-year overall survival rates of the two groups were 81%, 37%, 29% and 61%, 39%, 23% (χ~2 = 0.06, P = O. 804), respectively. Both lo-cal control and overall survival were similar between the two groups. The incidences of acute radiation esoph-agitis in the two groups were similar (85% vs. 89% ;χ~2 =0. 00,P=0. 959), and the incidence of radiation pneumonitis was slightly higher in group A than in group B (67% vs 43% ;χ~2 =3.14,P =0.076). By the last follow up, 19 patients in group A and 21 in group B died. Among them, 10 in group A and 15 in group B died of local failure, while 7 in group A and 5 in group B died of metastasis. Conclusions When com-pared with conventional fractionation 3DCRT, late course accelerated 3DCRT for esophageal carcinoma can achieve better results in clinical response, though not in long-term local control or survival. The incidence of acute radiation esophagitis and pneumonitis is clinically acceptable.