45例食管癌后程加速超分割放疗的疗效

目的探讨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。方法对90例食管鳞状细胞癌随机分为2组,常规分割对照组45例,每周5次,每日1次,每次DT1.8Gy,总剂量DT64.8Gy/7.2W。后程超分割组45例,前2/3照射量DT43.2Gy/4.8W同常规对照组,第5周起进行加速分割照射,每日2次,每周5天,每次DT1.5Gy,间隔6小时,总剂量DT64.8Gy/6.2W,所有病例均采用60Co远距离外照射。结果局控率后程超分割组97.8%(44/45),常规对照组95.6%(43/45)两组比较无差别P>0.05);1、2、3年生存率分别为95.6%(43/45)、71.1%(32/45)、64.4%(29/45)及48.9%(22/45),35.6%(16/45),28.9%(13/45)两组比较有极显著性差异(P<0.01);急性放射反应在放疗结束时,后程超分割组明显高于常规对照组,两组比较有显著性差异(P<0.05)但能耐受;死亡原因是局部复发,其次是出血、穿孔、远地转移,两组比较无差异(P>0.05)。结论食管中、上段鳞状细胞癌采用后程加速超分割放射治疗技术优于常规分割放射治疗,急性放射反应较重,但能耐受,不增加并发症。

The study of 45 esophageal carcinoa patients treated by late course accelerated fractionation radiotherapy

Objective To study the longterm efficacy of the late course accelerated fractionation radiotherapy for esophageal carcinoma.Methods A total of 90 patients with esophageal carcinoma,were randomized into two groups: the conventional fractionation radiation group(45 patients) received 1.8 Gy per day,(CFR)5 times a week. To a total dose of 64.8Gy in 7.2weeks,the late course accelerated hypekfraltion radiation(LCHR) group(45patients) received the same schedule as CFR group during the first two thirds of the course of radiotherapy(43.2Gy per 4.8 weeks).then followed by accelerated fractionation 1.5Gy a day,with an interval of 6 hours between fractions to a total dose of 64.8Gy/6.2 weeks,ten times a week.The same Cobalt 60 radiotherapy was used in both groups.Results The local control rates were 97.8%(44/45) in LCHR group and 95.6%(43/45) in CFR group.There was no significant difference between two groups.The one,two and three-year survival rates were 95.6%(47/45), 71.1%(32/45),64.4%(29/45) in LCHR group and 48.9%(22/45),35.6%(16/45)28.9%(13/45) in CFR group,raspectively.The survival rates in LCHR group were much better than that in CFR group(P<0.01). The acute clinical radiotherapy symptoms in LCHR group were much severely than that in CFR group(P<0.05).No differences of death cauces(local recurrence,bleeding.fistula,tele-transfaction) were found in both groups.Conclusion The therapeutic efficacy of patients with esophageals carcinoma in LCHR group was better than that in CFR group,without any complication,except the severely acute clinical radiotherapy symptoms.