后程加速超分割放射治疗食管癌的长期疗效

目的评价后程加速超分割放射治疗食管癌的长期疗效及放射反应和并发症。材料与方法１９８８年４月至１９９０年４月，８５例食管鳞癌随机分为２组：常规分割放射组４２例，每天１．８Ｇｙ，每周５次，总剂量６８．４Ｇｙ，总疗程７～８周；后期加速超分割放射组４３例，前２／３病程放射方法伺常规放射组，４～５周内照射４１．４Ｇｙ／２３次，然后缩野进行加速分割照射，每日２次，每次１．５Ｇｙ，间隔４～６小时，总疗程６．４周，总剂量６８．４Ｇｙ／４１次，所有病例均采用６０Ｃｏ远距离外照射，，结果５年实际生存率和原发肿瘤局控率，与常规分割组比较，后程加速超分割组明显提高，分别为３２．６％比１４．３％和５５．８％比２６．２％。复发中位时间，后程加速超分割组为８个月，明显长于常规分割组的４个月（ｐ＝０．０３），后程加速超分割组急性放射反应明显高于常规分割组，但患考能耐受，全部顺利完成疗程，后期放射损伤２组无显著差别。结论本组较少病例研究的初步结果显示食管癌后程加速超分别放射的疗效优于常规分割放射，患者能很好耐受后程加速超分割放射治疗方案。

Long term results of late course accelerated fractionation radiotherapy for esophageeal carcinoma

Purpose To evaluate the efficacy of the accelerated fractionation boost at the last two weeks of the radiotherapy course for esophageal carcinoma . Materials and Methods 85 patients with esophageal carcinoma were randomized into two groups : The conventional fractionation group ( CF ) received routine radiotherapy ( 1 . 8Gy per day, 5 times a week to a total dose of 68 . 4Gy in 7 - 8 weeks ) ; the late course accelerated fractionation group ( LCAF) received the same schedule as CF group during the first two thirds of the course of radiotherapy ( 41 . 4gy /23fx/4 - 5 weeks) then followed by accelerated fractionation using reduced fields changed into 1 . 5Gy twice a day, with an interval of 4 to 6 hours between fractioins to a total dose of 68. 4Cy /41fx/6 . 4 weeks. The same Cobalt 60 radiotherapy was used in both groups. Results The 5 - year actuarial survival and local tumor control rates in the LCAF group were significantly improved when compared to t he CF group, being respectively 32 . 6 % vs 14 . 3 % , and 66 . 8 % vs 26 . 2 % . The median time of radiation treatment to recurrence of primary lesion was 8 months in the LCAF group and 4 month in the CF group ( P = 0 . 03) . The acute reactions were increased but acceptable in the LCAF patients, and the radiation treatments were able to be completed without any break . The late reactions as observed after 6 years were not increased in comparison with the CF patients . Conclusion The preliminary results from our study in a small group of patients has shown that late course accelerated fractionation schedule for radiotherapy of esophageal carcinoma can give better survival rate than conventional radiotherapy . The reactions of the LCAF treatment can be tolerated.