食管癌常规照射及后程加速超分割适形放疗的临床探讨

The Studies on Late Course Accelerated Hyperfractionation Stereotactic Conformal Radiotherapy for Esophageal Carcinoma

目的:评价常规照射及后程加速超分割适形放射治疗食管癌的疗效。方法:将155例食管鳞癌随机分为两组:常规分割组(CF)75例,2Gy/次,5次/周,总剂量60～70Gy,30～35分次,6～7周完成;后超组(LCAHF)80例,先常规照射40Gy/4周,2Gy/次,5次/周,从第5周起超分割适形照射,1.5Gy/次,2次/天,间隔6h以上,24Gy/1.5周,总剂量64Gy,5.5周完成。结果:1、2、3年生存率CF组为54.7%、42.7%、25.3%,LCAHF组为83.8%、61.3%、41.3%。1、2、3年局部控制率CF组为54.7%、46.7%、30.7%,LCAHF组为81.3%、63.8%、53.8%。两组有显著差异(P<0.05),而放射治疗不良反应和并发症两组无显著性差异(P>0.05)。结论:常规照射及后程加速超分割适形放疗较常规分割放疗能提高生存率和局部控制率,放射治疗不良反应及并发症低。

Objective: To evaluate the therapeutic effects of late course accelerated hyperfractionation stereotactic conformal radiotherapy for esophageal carcinoma. Methods: One hundred and fifty-five patients with squamous cell carcinoma of esophagus were randomized into two groups: 75 patients were divided into the convention fractionation radiotherapy group and 80 the LCAHF SRT group. The patients of CF group received a total dose of 60 to 70Gy, at 2Gy daily, 5 days per week. While, in the LCAHF group, all patients first received a mean dose of 40Gy/4wks followed by 24Gy/16fs/1.5wks, 1.5Gy/fs, twice daily. DT 64Gy/36fs/5.5wks were delivered. Results: The 1-, 2-, 3-year survivals rate were 54.7%, 42.7%, 25.3% in the CF, and 83.8%, 61.3%, 41.3% in the LCAHF, respectively. The 1-, 2-, 3-year local control rate were 54.7%, 46.7%, 30.7% in the CF, and 81.3%, 63.8%, 53.8% in the LCAHF, respectively. The difference was significant (P<0.05). There was no significant differences on acute complications or specific sequelae between the two groups (P>0.05). Conclusion: The results from this study show that the late course accelerated hyperfractionation stereotactic conformal radiotherapy can improve the survival rate and local control rate of esophageal carcinoma, without increasing any untoward radioreactions or complications.