食管癌放疗后复发的三维适形放射治疗近期临床疗效分析

目的研究三维适形放射治疗常规放射治疗后复发食管癌的可行性，观察近期疗效与早期并发症的发生率。方法对38例食管癌常规放疗后复发病例行三维适形放射治疗，评价急性放射反应及近期疗效。结果38例患者均顺利完成治疗。初次放射治疗至再放射治疗的中位间隔时间为19个月（12—32个月），再放射治疗肿瘤中位剂量入为54Gy（50～60Gy），近期疗效为完全缓解占10．5％，部分缓解占52．6％，无变化占26．3％，进展占10．5％，总有效率为63．1％。根据RTOG分级急性放射性食管炎发生率1—2级13．1％（5／38），3级5．26％（2／38），4级0（0／38）；急性放射性肺炎发生率1—2级13．1％（5／38），3～4级0（0／38），骨髓抑制发生率1～2级31．6％（12／38），3—4级0（0／38），心脏损伤发生率1—2级7．9％（3／38），3—4级0（0／38）。结论三维适形放射治疗复发食管癌有较好的疗效，早期并发症较低，能为患者耐受，晚期并发症的发生率及远期疗效有待进一步观察。

3-D conformal therapy for postradiation recurrent esophageal carcinoma

Objective To evaluate the feasibility of reirradiation for postradiation recurrent esophageal carcinoma using 3-dimensional conformal radiotherapy(3D-CRT)and to assess the immediate response and acute side-effect.Methods38 esophageal carcinoma patients with local recurrence after their initial radiotherapy received retreatment with 3-DCRT.The immediate response and acuate side effect were evaluated.ResultsAll 38 patients completed their second-course radiotherapy.The median period between the course was 19 months(12-32).The median radiation therapy dose to the gross tumor volume(GTV)was 54 Gy(50-60 Gy).The overall immediate response rate(CR PR)was63.1%(24/38).According to the RTOG criterion,Grade 1-2 acute radiation esopiagitis occurred in 71%(27/38)and Grade 3 occurred in5.3%(2/38).Grade 1-2 acute radiation pneumonitic occurred in13.1(5/38)patients.Grade 1-2 bone marrow suppression occurred in 31.6(12/38)of patients and Grade 1-2 myocardial injury was present in 7.8(3/38)of patients.The median follow-up duration was 5 months.Conclusion3-D conformal radiotherapy can be considered as an effective and feasible approach to re-treat postradiation local reccurrence of esophageal carcinoma with good response and without any early serious complications.Long-terms survival and possible specific injury should await further study.