后程加速超分割放射治疗联合化疗治疗中晚期食管癌

Late course accelerated hyperfractionation radiotherapy plus concurrent chemotherapy on esophageal carcinoma

比较后程加速超分割放射和常规分割放射联合化疗治疗食管癌的疗效和毒性。将 12 5例胸段食管鳞癌患者随机分成 2个组 :1)常规分割放化 (CF +C)组 63例 ,5次 /周 ,2 0Gy/次 ,总量 66Gy。 2 )后程加速超分割放化 (LCAF +C)组 62例 ,先常规照射DT40Gy/ 4周 ,改 2次 /d ,1 3Gy/次 ,间隔≥ 6h ,加量至 66Gy。两组化疗均采用PLF(DDP、CF、5 FU)方案。CF +C组和LCAF +C组 1、2、3年生存率分别为 60 3 %、3 9 7%、2 3 8%和 83 9%、5 9 7%、41 9%。两组相比差异有统计学意义 ,P <0 0 5。LCAF +C组急性放射性食管炎的发生率高于CF +C组 ,晚期并发症无明显差别。两组的主要死亡原因是局部复发和未控 ,LCAF +C组明显低于CF +C组 (分别为 40 3 %、5 8 7% ) ,P <0 0 5。后程加速超分割放射加化疗治疗食管癌能显著提高疗效 ,虽急性食管炎的发生率增加 。

The objective is to compare the therapentic effects and toxicity of late course accelerated hyperfractionation radiotherapy (LCAF) and conventional fractionation radiotherapy (CF) with esophageal cancer, both plus concurrent chemotherapy.A fotal of 125 patients with squamous cell carcinoma of thoracic esophagus were randomized into two groups: 1)CF+C group,63 patients were irradiated 2.0 Gy/f, 5 times a week, to a total dose of 66 Gy; 2)LCAF+C group, 62 patients were first irradiated with CF to 40 Gy,then followed by 1.3 Gy/f bid, at more than 6 hours' interval, to the total dose of 66 Gy.In the two groups, the chemotherapy regimen was PLF (Cisplatin,Leucovorin and 5-Fluorouracil). The 1-,2-,and 3-year survival rates were 60.3%,39.7% and 23.8% in the CF+C group and 83.9%,59.7% and 41.9% in the LCAF+C group, with obvious better results in the latler group,P<0.05.The acute esophagitis was severer in the LCAF+C group than in the CF+C group, but there were no significant differences in late complications and the cause of death between the two groups. The main cause of death was local recurrence and uncontrolled primary disease, which was significantly lower in the LCAF+C group (40.3%)than in the CF+C group (58.7%),P<0.05. In conclusion, late course accelerated hyperfractionation radiotherapy plus chemotherapy can significantly improve the outcome of esophageal cancer. Though it increases acute esophagitis, all patients are well tolerated.