摘要
目的 分析临床Ⅲ期食管癌常规放射治疗后进行后程加速超分割三维适形放射治疗协同化疗的疗效、副反应及失败原因。方法 将食管鳞癌 98例随机均分至 2个组 :( 1)单纯放射治疗组前 2 / 3疗程常规设野放射治疗 4 0Gy左右 ,后 1/ 3疗程改为CT模拟定位三维计划系统设野后程加速超分割适形放射治疗 ,1.5Gy/次 ,2次 /d ,共 15~ 2 4Gy左右 ;总剂量为 5 5~ 6 4Gy ,30~ 36分次 ,全疗程35~ 4 0d。 ( 2 )协同化疗组在上述放射治疗的同时加用顺铂 2 0mg(第 1~ 5天 )、亚叶酸钙 2 0 0mg(第 6~ 10天 )、氟尿嘧啶 5 0 0mg(第 6~ 10天 ) ,2 8d为 1个周期 ,共 5个周期。结果 随访 8~ 4 8个月 ,单纯放射治疗组和协同化疗组的 1、2、3年生存率分别为 73%、5 3%、35 %和 76 %、73%、5 5 % ,协同化疗组高于单纯放射治疗组 ( χ2 =4 .12 ,P <0 .0 5 ) ;1、2、3年局部控制率分别为 76 %、5 9%、4 9%和 82 %、76 %、6 9 % ,协同化疗组高于单纯放射治疗组 ( χ2 =4 .2 2 ,P <0 .0 5 )。Cox回归分析显示病变部位是独立的预后因素 ,颈段、胸上段食管癌预后明显优于胸中段食管癌。结论 常规放射治疗后进行后程加速超分割三维适形放射治疗可作为颈段、胸上段Ⅲ期食管癌的首选方法之一 。
Objective To analyze the result of late course accelerated hyperfractionation (LCAFR) and three dimensional conformal radiotherapy plus concurrent chemotherapy (LCAFR+C)on stage Ⅲ esophageal carcinoma. Methods Ninety-eight patients with stage Ⅲ esophageal carcinoma were divided randomly into two groups:1. LCAFR group: patients were treated with conventional fractionated radiotherapy during the first two-thirds of the treatment to a dose of 40?Gy in 20 fractions over 4 weeks, then followed by LCAFR with reduced fields using three dimensional conformal radiotherapy to a dose of 15-24?Gy over 7-12 days, 1.5Gy per fraction, to the total dose of 55-64?Gy in 30~36 fractions over 35-40 days. 2. LCAFR+C group:The radiotherapy schedule was the same as the LCAFR group,but with concurrent chemotherapy of DDP 20?mg d1-5, LF 200?mg and 5-Fu 500?mg d 6-10 , 28 days in one cycle to totally 5 cycles. Results The 1-, 2-, and 3-year actuarial survival rates were 73%, 53%, 35% and 76%, 73%, 55% respectively (χ 2=4.12,P<0.05). The 1-, 2-, and 3-year local control rates were 76%, 59%, 49% and 82%, 76%, 69% respectively (χ 2=4.22,P<0.05). The Cox multivariate model indicated that the tumor location was the sole prognostic factor, ie, the results were superior to others if the tumor was located either in cervical or upper segment. Conclusions Late-course accelerated hyperfractionation can be taken as the first choice for patients with stage Ⅲ cervical and upper thoracic esophageal carcinoma. Three dimensional conformal radiotherapy plus concurrent chemotherapy can improve the local control and survival rates,but with increased toxicity.
出处
《中华放射肿瘤学杂志》
CSCD
北大核心
2004年第4期265-267,共3页
Chinese Journal of Radiation Oncology
关键词
食管癌
后程加速超分割三维适形放射治疗
化疗
疗效分析
预后
Esophageal neoplasms/radiotherapy
Dosage fractionation
Esophageal neoplasms/chemotherapy
Prognosis