诱导化疗加后程超分割放疗治疗溃疡性食管癌的临床疗效分析

目的:诱导化疗加后程超分割放疗治疗溃疡性食管癌的临床疗效分析。方法:分析我院放疗科2009年4月至2012年8月期间148例资料完整、采用诱导化疗加后程超分割放疗治疗的溃疡型食管癌患者的疗效。数字分组法，随机分为观察组79人（诱导化疗+后程超分割放疗组）及对照组69人（诱导化疗+常规分割放疗组）。化疗方法:PF方案2周期;放疗方法:采用6MV-X射线，IMRT适形调强技术体外照射,观察组:初始低分割放疗，第1、2周分割剂量每次1.6 Gy，第3、4周分割剂量每次1.8 Gy，每周5次，前4周总量34 Gy/20次/4周；第5、6周后程超分割放疗，分割剂量每次1.25 Gy，每天2次，每次间隔时间≥6 h，每周5天，共30 Gy/24次/2.5周，总量64 Gy；对照组:常规分割剂量，每次2.0 Gy，每周5次，总量64 Gy/32次/6.5周。结果:观察组/对照组放疗完成率92.4％/78.3%,差异有统计学意义；溃疡愈合率:观察组/对照组是92.4%/82.6%，差异有统计学意义；观察组/对照组有效率（CR+PR）分别为92.4%/79.7%,组间差异有统计学意义；观察组/对照组1、3、5年局控率分别为82.3%/59.4%、54.4%/43.5%、36.7%/14.5%，1、3、5年生存率为79.7％/68.1%、39.2％/29.0%、15.2％/8.7%，尤其是1年、5年局部控制率与5年生存率，观察组明显优于对照组，差异有统计学意义；毒副反应:急性黏膜反应，尤其Ⅰ-Ⅱ级观察组明显高于对照组（P＜0.01），差异有统计学意义；晚期放射性损伤主要是食管狭窄，观察组明显低于对照组:Ⅰ-Ⅱ级20.3%/69.6%,Ⅲ级0/11.6%(P＜0.01)，差异有统计学意义。结论:采取诱导化疗2周期+初始低剂量放疗+后程超分割放疗的方法治疗溃疡性食管癌，确实减少了食管穿孔出血的风险，降低了食管狭窄的发生率，毒副作用未见明显增加，值得临床进一步研究。

The clinical efficacy analysis of induction chemotherapy plus late course hyperfractionation radiotherapy in the treatment of ulcerative esophageal carcinoma

Objective:The clinical Efficacy Analysis of induction chemotherapy plus late course hyperfractionation radiotherapy in the treatment of ulcerative esophageal carcinoma.Methods:Analysis of the clinical efficacy of induction chemotherapy plus late course hyperfractionation radiotherapy in the treatment of ulcerative esophageal carcinoma patient whoes in the Radiotherapy Dept.in our hospital during April 2009 and August 2012,a total of 148 cases.It was divided into observation group of 79 cases (induction chemotherapy+late hyperfractionation radiotherapy group) and control group of 69 cases(induction chemotherapy+conventional fractionated radiotherapy group) using random number grouping.Chemotherapy:PF scheme 2 cycle.Radiotherapy methods:6 MV-X-ray,conformal IMRT in vitro irradiation.Observation group:The initial radiotherapy divisional dose is 1.6 Gy each time at the first and second week,the divisional dose is 1.8 Gy each time at the third and fourth week,5 times a week,the total dose is 34 Gy/20 times at the first 4 weeks.Late course hyperfractionation radiotherapy ivisional dose is 1.25 Gy each time,2 times a day,interval time between 2 times≥ 6 h,total dose is 30 Gy/24 times/2.5 weeks.The total dose is 64 Gy.Control group:conventional fractionated radiotherapy,5 times a week,the divisional dose is 2.0 Gy each time,total dose is 64 Gy/32 times/6.5 weeks.Results:The actual completion of treatment:the observation group/control group is 92.4%/78.3%,the difference was statistically significant.Ulcer healing rate:The observation group/control group is 92.4%/82.6%,the difference was statistically significant.The effective rate (CR+PR) of the observation group/control group was 92.4%/79.7%,the difference between the two groups was statistically significant.The 1,3 and 5-year local control rates in observation group and control group were 82.3%/59.4%,54.4%/43.5% and 36.7%/14.5% respectively,the survival rate of 1,3 and 5-year was 79.7%/68.1%,39.2%/29.0%,15.2%/8.7%,especially the local control rate of 1 and 5-year and survival rate of 5-year of observation group was significantly better than the control group,the difference was statistically significant.Side effects:Acute mucosal reaction,especially Ⅰ-Ⅱ grade,the incidence of observation group was significantly higher than that of the control group (P＜0.01),the difference was statistically significant.Advanced radiation injury was mainly esophageal stenosis,the incidence of observation group was significantly lower than the control group:Ⅰ-Ⅱ grade is 20.3%/69.6%,Ⅲ grade is 0/11.6%(P<0.01),the difference was statistically significant.Conclusion:The treatment of inducing chemotherapy for 2 cycles+initial low-dose radiotherapy+late course hyperfractionation radiotherapy+adjuvant chemotherapy 2 weeks can reduce the risk of esophageal perforation bleeding and the incidence of esophageal stenosis,and not significantly increase the side effects.This approach deserves further clinical study.