食管癌放疗后复发三维适形放疗的临床观察

Three-dimensional Conformal Radiationtherapy for Loco-regionally Recurrent Esophageal Cancer after Initial Radiotherapy

目的探讨三维适形放疗(3DCRT)在食管癌首程放疗后局部复发患者中应用的疗效、放射性损伤及影响因素。方法 38例首程放疗后局部复发的食管癌患者,采用3DCRT技术进行二程放疗。放疗处方剂量中位值56Gy(50～64Gy),1.8～2.0Gy/次,5次/周。结果随访截至2009年12月31日,随访率为100.0%。38例患者中完全缓解8例,部分缓解27例,无进展或恶化3例。全组患者1、2、3年总生存率分别为68.4%、23.7%、15.8%。全组≥2级放射性食管炎14例,≥2级放射性肺炎9例,≥2级血液学副反应4例。本组共死亡32例,其中死于局部复发15例、远处转移6例、食管瘘2例、食管狭窄1例、全身衰竭4例、其他疾病2例、死因不详2例。结论食管癌首程放疗后局部复发采用3DCRT二程放疗是可行的,有较好临床症状缓解率和即时疗效,部分患者可延长生存期,但再程放疗并发症较高,临床应用时应严格掌握其适应证。

Objective To evaluate the feasibility,therapeutic effects and normal tissue complications of three-dimensional conformal radiotherapy(3DCRT) for loco-regional recurrent esophageal cancer after initial radiotherapy.Methods 38 patients with loco-reigonal recurrent esophageal cancer after initial radiotherapy were treated with 3DCRT.Radiotherapy was delivered at 1.8～2.0 Gy per fraction,5 fractions per week,with a median total dose of 56 Gy.Results By December 31,2009,the follow-up rate was 100.0%.Among the 38 patients,8 patients achieved,complete remission 27 patients achieved partial remission.The overall 1-,2-and 3-year survival rates were 68.4%,23.7% and 15.8%.32 patients died,of which 15 from local recurrence,6 from distant metastases,2 from esophageal leak,1 from esophageal narrow,4 from systemic failures,2 from other diseases,and 2 from unknown causes.Conclusion For patients with loco-regional recurrences of esophageal cancer after initial radiotherapy,3DCRT is feasible,with a good clinical symptom relief rate and immediate tumor response.However,the complication rate is high and the clinical indications should be strictly controlled.