常规与后加速超分割及常规加腔内照射治疗食管癌的远期疗效

Comparison between conventional fractionation, late-course accelerated hyperfractionation and external beam combined with intracavitary radiation in the treatment of locally moderate and advanced esophageal carcinoma

目的 观察和比较常规分割、后程加速超分割及常规分割加腔内照射三种方式治疗局部中晚期食管癌的疗效及放射反应。方法 对 111例局部中晚期食管癌首治病例进行前瞻性随机分组研究。常规分割照射组 (常规组 ) 4 0例 :2 .0Gy/次 ,1次 /d ,5d/周 ,共 6 0Gy,30分次 ,6周完成。后程加速超分割组 (后超组 ) 4 1例 :前 3周常规分割 ,30Gy ,15分次 ,3周完成 ;后 2周加速超分割照射 ,1.5Gy/次 ,2次 /d ,5d/周 ,共 30Gy ,2 0分次 ,2周完成。常规外照射加腔内照射组 (腔内组 ) 30例 :常规外照射达 34～ 36Gy时与腔内照射同期进行 (腔内照射当天停外照射 1次 ) ,腔内照射 5 .0Gy/次 ,1次 /周 ,共 2次 ,外照射总量为 5 0Gy。结果 常规组和后超组及腔内组的 1、3、5年生存率分别为 5 7.5 %、2 2 .5 %、14 .1%和 5 7.5 %、2 9.3%、2 4 .4 %及 5 3.3%、2 6 .7%、2 3.3% ,急性放射性食管炎的发生率分别为 2 2 .5 %和 4 1.5 %及 5 0 .0 % ,出血、穿孔的发生率分别为 7.7%和 7.3%及 16 .7%。结论 虽然后程加速超分割放射治疗有提高生存率的趋势 ,但与常规分割照射组及常规外照射加腔内放射治疗组的生存率差异无显著性意义 。

Objective To compare the results of conventional fractionation, late-course accelerated hyperfractionation and external beam combined with intracavitary radiation in the treatment of locally moderate and advanced esophageal carcinoma. Methods From May 1994 to June 1995, 111 patients with squamous cell carcinoma were randomized into three groups: conventional fractionation group (CF), late-course accelerated hyperfractionation group (LCAH), and external beam combined with intracavitary radiation group (EBIR). In CF group, 40 patients were treated by conventional fractionated irradiation to the dose of 60?Gy in 30 fractions over 6 weeks. In LCAH group, 41 patients were first treated with conventional fractionated irradiation to a dose of 30?Gy over weeks, then by accelerated hyperfractionated irradiation to a dose of 30?Gy over 2 weeks, 1.5?Gy per fraction, twice daily with 6 hour interval. In EBIR group, 30 patients were first treated with conventional fractionated radiation to a dose of 35?Gy over 3.5 weeks, then with external and intracavitary radiation used concomitantly ( 5.0?Gy per fraction, once a week to 10?Gy in 2 fractions) with irradiation skipped on the day of intracavitary radiation. The total dose of external irradiation was 50?Gy. RResults The 1-,3- and 5-year survival rates of CF, LACH and EBIR groups were 57.5%, 22.5%, 14.1%; 57.5%, 29.3%, 24.4% and 53.3%, 26.7%, 23.3% (P>0.05), respectively. Higher acute esophagitis rate was observed both in LACH and EBIR groups, with more perforation and massive hemorrhage observed in EBIR group. Conclusions No significant improvement of survival rate has been observed either in LCAH group or EBIR group. A larger accrual of patients is needed to determine the value of late course accelerated fractionated radiotherapy or external beam radiation combined with intracavitary radiation in the treatment of esophageal carcinoma.