三维适形后程加速超分割联合PF方案诱导同期化疗治疗中晚期食管癌的临床观察

目的评估三维适形并后程加速超分割联合PF方案同期放化疗治疗中晚期食管癌的临床疗效。方法病理证实的中晚期食管癌65例随机分为单放组33例和放化组32例；放疗均采用6／15MV—X线外照射。各组放疗前2／3疗程常规放疗1．8Gy／次，5次／周，共40Gy，后1／3疗程改用加速超分割治疗，1．5Gy／次，2次／天，间隔6h以上，全疗程总剂量70Gy；放化组配合PF方案化疗，治疗结束后，按照食管癌诊治规范标准，比较两组疗效，第1、2、3年生存率及毒副反应。结果单放组CR36．4％，PR54．5％，1、2、3年生存率分别为39．4％、30．3％、24．2％；放化组CR43．8％，PR53．1％，1、2、3年生存率分别为68．8％、56．3％、50．0％，两者近期疗效无统计学差异（P〉0．05），放化组生存率显著高于单放组（P〈0．05）；局部毒副作用两组比较差异无统计学意义（P〉0．05），放化组全身毒副作用高于单放组（P〈0．05）。结论三维适形后程加速超分割联合PF方案治疗能明显提高中晚期食管痛的1、2、3年牛存率．且不增加局部毒副反廊。

A clinical study of concurrent chemoradiotherapy with 3D-CRT late-course hyperfractionated accelerated radiation therapy plus the DF project induction for intermediate and advanced esophageal carcinoma

Objective To evaluate the clinical effects of concurrent chemoradiotherapy with 3 D - CRT late - course hyperfractionated accelerated radiation therapy （LCAHF） plus the prognostic factors （PF） project induction on intermediate and advanced esophageal carcinoma. Methods 65 patients pathologically confirmed as having intermediate or advanced esophageal carcinoma were randomly allocated into two groups （33 in radiotherapy group and 32 in complex or chemoradiotherapy group）. All patients were given external beam radiation of 6/15 MV X -ray. During the first two- thirds of the course, the patients received a routine dose of 1.8 Gy per fraction, five times per week, at a dosage of 40 Gy in both groups. For the one - thid that followed, LCAHF was given at a dose of 1.5 Gy, twice daily, at an interval of more than 6 hours, with the total dosage of 70 Gy. In complex group, chemotherapy regimen was combined with DF project. At the end of treatment, the efficiency, respective survival rates of 1, 2 and 3 years, toxicity as well as side effects between the two groups were compared, based on Guidelines for Diagnosis and Treatment of Esophageal Carcinomas. Results In the radiotherapy group, CR was 36.4% and PR was 54.5%, and in the complex group, CR was 43.8% and PR was 53.1% , respectively. The 1 - , 2 - , 3 - year survival rates were 39.4%, 30.3% , 24.2% in the radiotherapy group and 68.8% , 56.3% , 50.0% in the complex group, respectively （ P 〈 0.05 ）. The difference between the regional toxicity and side effects in the two groups were not statistically significant （ P 〉 0.05 ）, while in the complex group, the regional toxicity and side effects were higher than in the radiotherapy group （P 〈 0.05 ）. Conclusions 3D - CRT with LCAHF plus PF project chemotherapy can remarkably promote the 1 - 2 - 3 - year survival rates of intermediate and advanced esophageal carcinoma patients without increasing regional toxicity and side effects and is was worthy of clinical generalization.