逐步递量加速超分割放射治疗食管癌

Escalated Hyperfractionated Accelerated Radiation Therapy for Esophageal Carcinoma

目的 观察逐步递量加速超分割放射治疗 (EHART)食管癌的近期疗效和放射副作用。方法 60例II～III期食管鳞癌病例随机分为两组 ,常规分割放射治疗 (CFRT)组 3 0例 ,方法为 2Gy/次 ,5次 /周 ,总剂量 60Gy ,3 0分次 ,6周完成 ;EHART组 3 0例 ,方法为放射治疗的第 1～ 2周 ,1 8Gy/次 ,每天 1次 ,第 3周为 1 2Gy/次 ,每天 2次 ,间隔 6h以上 ,第 4周为 1 4Gy次 ,2次间隔 6h以上 ,第 5周为 1 6Gy次 ,2次间隔 6h以上 ,总剂量 60Gy ,40分次 ,5周完成。结果 CFRT组原发灶完全缓解 (CR) 3 6 7% (11/ 3 0 ) ,部分缓解 (PR) 3 6 7% (11/ 3 0 ) ,无变化 +病变进展 (NR +PD)占 2 6 7% (8/ 3 0 ) ,总有效率为 73 3 % ;EHART组CR占 5 0 0 % (15 / 3 0 ) ,PR占43 3 % (13 / 3 0 ) ,NR +PD占 6 7% (2 / 3 0 ) ,总有效率为 93 3 %。EHART组明显优于CFRT组 ,两组差异有显著性意义 (P <0 0 5 ) ;而放射治疗副反应和并发症两组差异无显著性意义 (P >0 0 5 )。结论 EHART能为食管癌患者耐受 ,没有明显增加放射治疗副作用及并发症 ,有较好的近期疗效。 1、3、5年生存率及晚期损伤有待进一步随访。

Objective To assess the immediate responses and side_effect of escalated hyperfractionated accelerated radiation therapy (EHART) for esophageal carcinoma. Methods From May 2000 to Dec.2003,60 patients with squamous cell carcinoma of esophagus were randomized into two groups:30 patients entered the convention fractionation radiation therapy and received a total dose of 60 Gy,at 2Gy daily,5 days per week. While in the EHART group, hyperfractionated irradiation was delivered with twice fractions daily (with 6 hours interval ) and five-treatment-days per week.In the first and second weeks, 1.8Gy /fraction qd was given, then 1.2Gy /fraction bid,in the 3rd week,1.4Gy/fraction bid, in the 4th week,and 1.6Gy /fraction bid in the 5th week. The total tumor dose was 60Gy/40fx/5wk. Results For esophageal primary tumor, the overall response rate (CR+PR) was 76.7%(23/30) in the CFRT, and 93.3%(28/30) in the EHART. The overall response rate in EHART group was much better than those in CFRT group (P<0.05). There was no significant difference on acute complications or specific siquelae between the two groups (P>0.05). Conclusions EHART could be tolerated by all of the patients with esophageal carcinoma, and without increasing any untowards radioreactions or complications. The immediate response of tumor is encouraging. However, the 1-, 3-, 5-year survival rates and late injuries need further follow-up.