腔内热疗合并体外放射治疗食管癌的疗效

目的：比较食管腔内微波加温合并体外放射治疗食管癌与单纯放射治疗的疗效。方法：对125例食管癌进行前瞻性分组研究。食管腔内加温合并体外照射（R＋H）组59例，单纯体外照射（RT）组66例，R＋H组外照射DT40Gy，腔内加温1－2次／周，45min／次，要求肿瘤表面温度＞43℃。RT组外照射DT60Gy，2Gy／次，5次／周。结果：近期疗效显著,R H 完全缓解率达46．0％，RT组为24．0％，差异有显著性意义（P＜0．05）。1、5、10年生存率R＋H组分别为81．2％，23．7％和15．2％，RT组分别为59．0％、16．7％和7．5％。将平均T90≥43℃的病例进行统计，R＋H组的5、10年生存率是26．9％和17．3％，分别高出对照组10．2％和9．8％。结论、食管腔内加温合并体外放射治疗可以提高食管癌的局部控制率，近期疗效和远期疗效均高于对照组，局部控制率的高低与加温的次数无明显关系，关键在于每次的加温质量（T90的高低）。

Results of intraluminal hyperthermia combined with external irradiation for esophageal carcinoma

Objective　To compare the long-term survival rate between intraluminal microwave hyperthermia combined with external irradiation and radiotherapy alone. Methods　A randomized trial on intraluminal microwave hyperthermia combined with external irradiation (R+H) versus radiotherapy alone (R) in esophageal cancer was performed from February 1986 to February 1988. In the R group, radiation was given by 8 MV X-ray with 2 Gy/fraction, 5 fractions per week with a total dose of 60 Gy/6 weeks. In the R+H group, the radiation was given with a total dose of 40 Gy/4 weeks. Intraluminal 915 MHz microwave hyperthermia was given with a nominal temperature of 43.5℃ at the margin of the tumor surface, 45 minutes/fraction, once or twice a week for 4-8 fractions. Results　The 1-, 5-, 10-years survival rates were 81.2%, 23.7% and 15.2% in group R+H, and 59.0%, 16.7% and 7.5%, in the R group, respectively. For 52 patients who received hyperthermia with T90 equal to or higher than 43℃, survival rates at 5- and 10-year were 26.9% and 17.3% for R+H group, and 10.2% and 9.8% for the R group. Conclusions　 Intraluminal hyperthermia plus radiotherapy is able to improve the rate of local control in esophageal cancer. Hyperthermia plus radiotherapy gives a better long-term survival as compared to radiotherapy alone. There is no apparent correlation between the number of hyperthermia fractions and the rate of local control.