三维适形放疗联合同期化疗治疗食管多发癌的临床观察

 目的　分析食管多发癌三维适形放疗联合同期化疗的疗效及患者不良反应。方法　收集15例拒绝手术治疗的食管多发癌患者，采用直线加速器6 MV／10 MV X线分3～4个共面野进行适形照射，2 Gy／次，1次／d，5次／周；临床靶区剂量40～50 Gy／4～5周，肿瘤靶区剂量60 Gy／6周；同期采用TP方案（紫杉醇+顺铂）第1、29天联合化疗；化疗后第2天开始行三维适形放疗。结果　所有患者1、3年局部控制率和总生存率分别为86.7 %（13／15）、33.4 %（5／15）和73.3 %（11／15）、26.6 %（4／15）。不良反应：1～2级、3～4级急性放射性食管炎和白细胞减少症发生率分别为86.7 %（13／15）、13.3 %（2／15）和80.0 %（12／15）、20.0 %（3／15）。结论　对于近端病灶位于胸上段甚至颈段的食管多发癌，放疗是较好的治疗手段；三维适形放疗联合同期化疗治疗食管多发癌的不良反应可耐受。

Clinical observation on three-dimensional conformal radiotherapy combined with concurrent chemotherapy in the treatment of multiple primary carcinoma of esophagus

Objective　To analysis of the efficacy and toxicity of multiple primary cancer of esophagus in three-dimensional conformal radiotherapy and concomitant chemotherapy. Methods　Fifteen cases of multiple primary carcinoma of esophagus who refused the operation were collected. The Elekta linac 6 MV/10 MV X ray was used to conformal irradiation in three-four coplanar wild, 2 Gy/ time, 1 time/day, 5 times/week. The dose to the target area, CTV 40-50 Gy/4-5 weeks, GTV 60 Gy/6 weeks. TP scheme (paclitaxel+cisplatin) was used in the first day and 29th day, three-dimensional conformal radiation therapy initiated in the second day after chemotherapy. Results　1, 3 year local control and overall survival were 86.7 % (13/15), 33.4 % (5/15) and 73.3 % (11/15), 26.6 % (4/15). Class 1-2 and class 3-4 acute radiation esophagitis and leukopenia occurred rates were 86.7 % (13/15), 13.3 % (2/15) and 80 % (12/15), 20 % (3/15). Conclusion　Radiation therapy is the better treatment method for multiple primary carcinoma of esophagus when proximal lesions located in upper thoracic and cervical high. Toxic and side-effects can be tolerated of three dimensional conformal radiation therapy combined with chemotherapy in the treatment of multiple esophageal cancer.