食管癌术后局部复发的立体适形放疗疗效分析

3-Dimensional Conformal Radiotherapy for Local-Recurrence After Resection of Esophageal Carcinoma

目的 评价立体适形放射治疗食管癌术后局部复发灶的近期疗效。方法 2 0 0 0年 1月至 2 0 0 2年 12月间收治的 2 5例食管癌术后纵隔瘤床区复发或纵隔加吻合口复发病例 ,采用CT模拟定位技术和立体适形放疗技术 ,PTV为CTV外放 1 0cm ,采用 5～ 7个非共面野照射 ,用剂量体积直方图和等剂量线优化治疗计划 ,15MVX线 ,单次剂量 3Gy ,每周 5次 ,总剂量 60～ 66Gy ,PTV被 85 %等剂量线所包绕 ,PTV均匀性为 95 %～ 10 7%。结果 近期疗效为CR 4例 ,PR 2 1例 ,总有效率为 10 0 %。1、2年生存率及 1年局控率分别为 72 %、3 2 %、88%。按RTOG标准评价 :急性放射性食管炎Ⅰ～Ⅱ级 6例 (2 4% ) ,Ⅲ级 1例 (4 % ) ,急性放射性肺炎Ⅰ～Ⅱ级 8例(3 2 % ) ,Ⅲ级 1例 (4 % ) ,骨髓抑制Ⅰ～Ⅱ级 4例 (16% ) ,急性心脏损伤Ⅰ～Ⅱ级 2例 (8% )。结论 立体适形放射治疗能有效提高食管癌术后局部复发灶的局部控制率 ,改善临床症状 ,延长生存期 ,是局部剂量升级的有效方法 ,能提高生存质量 ,近期疗效满意。

Objective To evaluate the effects of 3-dimensional conformal radiotherapy for locoal-recurrence after resection of esophageal carcinoma.Methods From January 2000 to December 2002,25 patients with local_recurrence after resection of esophageal carcinoma were evaluated.21 cases in the mediastinum and 4 cases in mediastinum plus anastomotic orifice.Topiane three dimensional treatment planning system(3D-TPS)was used to design the dose-escalation treatmant plan and DVHs was used to optimize it.The planning target volume(PTV)encompassed 1.0cm outside the clinical target volume(CTV).These patients received radiotheraphy with 5-7 conformal fields to a dose of 60-66Gy,and were delivered in daily fractions of 3Gy,5days a week.Results 4 patients achieved CR,21 PR,with a total response rate of 100%.The 1,2-year survival rates were 72%,32% ,the 1-year local tumor control rates were 88%.According to the RTOG grading scheme,acute radiation esophagitis occurred in 24%of patients with Grade 1-2 and 4% with Grade 3 respectively.Acute radiation pneumonitis occurred in 32%of patients with Grade 1-2 and 4% with Grade 3 respectively.The bone marrow toxicity occurred in 16% with Grade 1-2.Damage to the heart occurred in 8% with Grade 1-2.Conclusions Dose escalation in local-recurrence after resection of esophageal carcinoma treatment using 3-dimensional conformal radiotherapy had an encouraging immediate response rate with lower acute complication.