同步整合加量调强放疗治疗颈及胸上段食管癌的临床观察

目的:观察同步整合加量调强放疗技术(SIB-IMRT)与常规调强放疗技术(IMRT)治疗颈及胸上段食管癌的不良反应及临床疗效.方法:颈及胸上段食管癌患者62例,随机分为SIB-IMRT组及常规IMRT组,同步给予单药顺铂同步化疗.处方剂量:SIB-IMRT组:PGTVnx 66Gy/(2.2Gy·30次),PGTVnd 66Gy/(2.2Gy·30次),PTV 54Gy/(1.8Gy·30次).IMRT组:95%PTV 60Gy/(2.0Gy·30次).结果:SIB-IMRT组1、2年的局部控制率(81.8%、64.5%)较IMRT组1、2年的局部控制率(73.5%、52.7%)提高(P<0.05).SIB-IMRT组1、2年的生存率(77.4%、50.7%)与IMRT组1、2年生存率(74.2%、50.1%)相比,两组差别无统计学意义(P＞0.05).两组患者放射性气管炎和血液学毒性的发生率差异无统计学意义(P＞0.05),SIB-IMRT组放射性肺炎、放射性食管炎的发生率较IMRT组降低(P<0.05).结论:SIB-IMRT治疗颈段及胸上段食管癌,有可能成为提高肿瘤剂量从而提高肿瘤局部控制率、延长患者生存的首选放疗方式.

The clinical observation of the imultaneously integrated boost intensity-modulated radiotheragy in cervical and upper thoracic esophageal carcinoma

Objective:To observe the toxicity and clinical efficacy of the two intensity modulated radiotherapy methods for incervical and upper thoracic esophageal carcinoma.Methods:Sixty two patients with cervical and upper thoracic esophageal carcinoma were divided into SIB-IMRT group and IMRT group randomly.Concurrent chemotherapy with Cisplatin.Target volumes for(PGTVnx:66Gy,2.2Gy×30 fractions,PGTVnd:66Gy,2.2Gy×30 fractions,PTV:54Gy,1.8Gy×30 fractions) were predefined for patients of SIB-IMRT group.Target volume for(95%PTV:60Gy,2.0Gy×30 fractions) were predefined for patients of IMRT group.Results:The median follow-up period was 18 months(range,10 to 24 months).And the follow-up rate was 100%.The effective rate of the two groups was 100%.1,2-year local control rate of the two groups(LCR) were 81.8%,64.5% and 73.5%,52.7% respectively.There was a statistically significant difference in LCR between SIB-IMRT and IMRT group.1,2-year OS(overall survival) were 77.4%,50.7% and 74.2%,50.1% respectively.There were no significant difference between the SIB-IMRT and IMRT groups.There were no significant difference in radiation induced bronchitis acute hematologic toxicity.There was statistically significant difference in radiation pneumonitis and esophogitisand.Conclusion:SIB-IMRT treatment for cervical and thoracic esophageal carcinoma technology was a treatment option to improve tumor local control rate and prolong the survival of patients.