食管癌术后纵隔转移灶同时加量调强放射治疗分析

目的：探讨食管癌根治术后纵隔转移灶同时加量调强放疗的意义和效果。方法：39例食管癌根治术后发生纵隔转移患者，设定原发灶和预防照射区进行SIB—IMRT（simultaneous integrated boost intensity-modulated radiation therapy）计划设计。定义2个靶区：P1rvl为需要加量照射的淋巴结靶区，给予69Gy（2．3×30次）；PTV2为预防照射区，给予54Gy（1．8×30次）的剂量，设计等角度5野调强计划。结果：5野调强获得了满意的剂量分布，患者可在6周内完成治疗计划，所有患者完成了放疗，治疗后3个月复查CT，病灶达CR（complete response）占66．7％（36／54），Pit（partial response）占33．3％（18／54），总有效率（CR＋PR）达到100．0％。结论：食管癌根治术后纵隔转移患者进行同时加量调强放射治疗物理学优势明显，可以明显提高局部控制率，急性放射治疗反应可耐受，具有良好的应用前景。

Simultaneous integrated boost intensity- modulated radiation therapy for mediastinum metastasis in patients with esophageal carcinoma after operation

Objective ：To investigate the clinical efficacy and significance of simultaneous integrated boost intensity -modulated radiotherapy （SIB -IMRT） for the patients with esophageal carcinoma after the radical esophagectomy and with mediastinal metastasis. Methods： SIB - IMRT plans were designed for 39 patients with esophageal carcinoma after the radical esophagectomy and with mediastinal metastasis. Two target volumes were predefined： PTV1, the target volume of the lymph node region,which was given to 69Gy（2.3Gy fractions）, and PTV2, the target volume of elec- tively treated region ,which was given to 54Gy（ 1.8Gy fractions）. Five equispaced coplanar beams were applied. Re- suits：The plan with 5 intensity - modulated beams could produce good dose distribution for the two target volumes. All the patients completed the treatments in 6 weeks. The outcome was evaluated 3 months after SIB - IMRT. Patients had CR in 66.7% （36/54） ;PR 33.3% （18/54）. The overall response rate was 100.0%. Conclusion： SIB - IMRT can reach a higher value of some radiation physical parameters for the patients with esophageal carcinoma after the radical esophagectomy and with mediastinal metastasis. Local - regional control rate was improved by using SIB - IMRT. The acute radiation toxicity of SIB - IMRT was well tolerated. SIB - IMRT is a promising radiotherapy modality for the advanced esophageal carcinoma.