食管癌内外放射治疗剂量与疗效关系的随机前瞻研究

目的研究内外放射剂量和放射治疗中食管Ｘ线片变化对中晚期食管癌局部控制和生存率的影响。方法１４６例食管鳞癌病人随机分外照射５０Ｇｙ、外照射７０Ｇｙ、外照射５０Ｇｙ＋腔内照射６Ｇｙ、外照射５０Ｇｙ＋腔内照射１２Ｇｙ，２分次４个组，分析各剂量组生存率和外放射４０Ｇｙ时Ｘ线片变化与生存率的关系；并观察５９例食管癌病人术前放射治疗剂量与切除标本病理反应的关系。结果（１）各组病人的１，２，３年生存率差异无显著意义；（２）外照射４０Ｇｙ时的食管Ｘ线片变化与预后有关。外照射４０Ｇｙ时Ｘ线片为１，２级者和３，４级者，中位生存期分别为２３个月和１２个月；１，２，３年累积生存率分别为７３．７％，５６．４％，３３．３％和４８．９％，２２．３％，１３．０％，Ｐ＝０．０００２６；（３）术前放射４０～４９Ｇｙ与５０～７０Ｇｙ比较，标本无癌率分别为３２．２％和３９．３％，差异无显著意义。结论不论是外照射还是腔内照射，在本研究采用的剂量范围内，高剂量并不能提高中晚期食管癌放射治疗效果。外照射４０Ｇｙ时食管Ｘ线片变化可作为估计放射治疗预后的指标。

Prospective randomized trial on dose response of esophageal cancer treated with radiotherapy with or without intraluminal brachytherapy

Objective To evaluate the results of esophageal carcinoma treated by different doses and methods of radiotherapy.Methods From July 1992 to February 1996, 146 cases of esophageal cancer were randomly allocated into four groups. Group A received 50Gy of external radiation(ER),group B 70Gy ER. Group C 50Gy ER plus 6Gy of brachytherapy(BR) in one fraction, and group D 50Gy of ER plus 12Gy of BR in two fractions. Fifty nine cases who received preoperative radiation were used to investigate the relation between radiation dose and histopathologic response. Results (1) Short term results evaluated by barium examination and 3 year survival rate analyzed by the Kaplan Meier test did not show any significant difference among these four groups, (2) All patients had their esophograms taken when 40Gy of ER. Those who had favorable X ray findings gave better survival than those who had unfavorable ones (1 2 and 3 year cumulative survivals: 73.7%, 56.4 %, and 33.3% vs 48.9 %, 22.3%, and 13.0%, respectively). (Log rank test P = 0.00026). (3)Pathological study confirmed that higher dose radiation did not significantly increase the response rate. Conclusions The higher doses used in this study, either ER or BR, do not improve the outcome advanced thoracic esophageal cancer. It seems that barium examination performed of at 40Gy ER is useful to predict the possibility of local control and long term survival.