两组食管癌放疗,化疗及热疗(三联)的热剂量比较

目的：对食管癌三联治疗两种方案的７５例及三联后手术７例，共８２例进行热剂量分析，看影响局控的因素。方法：第Ⅰ组，５Ｇｙ／周一次，共６次，热疗：４３．５℃，４５ｍｉｎ，化疗ＤＤＰ１．５ｍｇ／ｋｇ体重，ＰＹＭ２０ｍｇ，每周一次，共６次。Ⅱ组，３．６Ｇｙ／周二次，共１０次，热疗４３～４４℃，４５ｍｉｎ，周一次，化疗同Ⅰ组，共３次。以２年无临床复发，或因远处转移死亡，或术后标本Ⅲ级损伤为局控，２年内复发及标本损伤Ⅱ级的为未控。结果：Ⅰ组按计划完成治疗的局控率为６４％（７／１１），拖延疗期在７周以上或放疗量偏低的局控率为２２％（２／９）。第Ⅱ组只有３例未能按期完成治疗。热疗次数似与局部控制率无关。Ⅰ，Ⅱ组局控率Ｔ９０４３．０～４３．９℃组分别为５３％（１０／１９），４４％（１２／２７），Ｔ９０＞４４℃组为１７％（２／３），８９％（１６／１８）。两组Ｔ９０平均值分布与局控率呈典型的Ｓ状曲线，两组曲线相近。Ⅱ组Ｔ９０≥４３℃的病例５年存活率达３４．２％（１２／３５），而Ｔ９０≤４２．９℃的为０％（０／１３，Ｐ＜０．０５）。结论：虽然只测量肿瘤表面的两点温度，但由此得出的热剂量与局控率呈正相关。提高Ｔ９０使其＞４３℃是提高?

A Study on the Thermal Dose in Two Series Patients of Esophageal Cancer Treated by Intracavitary Microwave Hyperthermia Combined with Radiation and Chemotherapy

Objective: A thermo-dose study was performed in 82 cases of esophageal cancer of two regimes of thermo-chemo-radiotherapy (RTCH).Methods: Regime Ⅰ,20 cases;5 Gy/weekly/6 sessions,DDP 1.5/kg body wt,bleomycin A5 20 mg/session/weekly/6 sessions,intracavitary hyperthermia 43 ℃/45 min.Regime Ⅱ,55 cases;3.6 Gy/twice weekly/10 sessions,chemotherapy as regime I but only for 3 sessions, hyperthermia as regime I. Seven cases treated with pre-operative RTCH and surgery Their histological findings were correlated with thermo-dose.The patients who survived more than 24 months without evidence of recurrence and whose surgical specimen showing Ⅲ degree of tissue damage were classified as local control.Results: The patients finished their treatment on schedule was with a local control rate of 64%(7/11),while out of schedule 22%.Only 3 patients did not finished their treatment on time in patients of Regin Ⅱ.We found that the local control rates was not related to the number of treatment sessions but with the T 90 value.A typical dose-control probability S shaped curve was plotted with mean T 90 value.The local control rates was 23%,45% and 90%,with their T 90 <43℃,43～43.9℃ and ≥44℃ accordingly.The local control rate of Group Ⅰ,and Ⅱ with their T 90 43～43.9℃ were 45%(9/20) and 44% (12/27) and>44 ℃ were 100% (2/2) and 89% (16/18) respectively.The five year survival rate of Group Ⅱ was 34.2% in patients with T 90 ≥43.0℃,while 0% in patients with T 90 <43℃.Conclusion:T 90 is a good indicator as a thermal dose for intracavitary hyperthermia