后程加速超分割适形放疗同步化疗治疗食管癌的临床观察

Clinical study on esophageal carcinoma treated with concurrent chemotherapy and three dimensional conformal late course accelerated hyperfraction radiotherapy

目的:观察后程加速超分割适形放疗同步化疗治疗食管癌临床疗效。方法:69例患者随机分为两组:后加组(后程加速超分割适形放疗同步化疗组)35例和对照组(常规分割放疗同步化疗组)34例。采用6/15MVX线外照射,后加组常规分割放疗40Gy/20次后改为2次/d,间隔>6h,1.4Gy/次,总剂量为65.2Gy/38次。对照组2Gy/次,5次/周,总剂量60～66Gy。两组均从放疗第1天开始化疗,化疗方案如下:顺铂(DDP)20mg,替加氟1.0g,甲酰四氢叶酸钙(CF)0.2g,均静脉滴入,d1～d5,21d为1个周期。结果:后加组与对照组1年局部控制率分别为85.7%(30/35)和64.7%(22/34),P=0.043;后加组1年总生存率及疾病无进展生存率分别为77.2%和52.9%,对照组分别为71.5%和47.1%,P值分别为0.035和0.039;后加组2年预期生存率和疾病无进展生存率分别为68.9%和44.2%,对照组分别为60.0%和35.3%,P值分别为0.039和0.040。后加组Ⅱ、Ⅲ级急性放射性食管炎发生率分别为8.6%(3/35)和5.7%(2/35),对照组分别为8.8%(3/34)和5.9%(2/34);后加组Ⅱ、Ⅲ级急性放射性肺炎发生率分别为2.9%(1/35)和0,对照组分别为5.9%(2/34)和2.9%(1/34)。结论:与对照组相比,后程加速超分割适形放疗同步化疗治疗食管癌明显提高了患者的近期疗效及局部控制率,且正常组织的放射性损伤未明显增加。

OBJECTIVE.. To evaluate the efficacy of concurrent chemotherapy and three dimensional conformal late course accelerated hyperfraction radiotherapy for esophageal carcinoma. METHODS： Sixty-nine esophageal carcinoma patients were randomly divided into two groups： the late course accelerated hyperfraction radiotherapy （LCAHR） group and the control group. The LCAHR group consisted 35 cases and the control group consisted 34 cases. 6 MV X ray or 15 MV X ray was employed. The schedule of LCAHR group was as followingz conventional radiotherapy of 2 Gy per day was employed during the first phase to a total dose （TD） of 40 Gy, followed by LCAHR （twice fractions per day, interval between two fractions more than 6-hour, 1.4 Gy/Fx, 25.2 Gy in 9 days, a TD of 65.2 Gy）. The control group： 2 Gy per fraction, 5 fractions per week with the TD of 60 - 66 Gy. Radiotherapy and chemotherapy were used simultaneously, chemotherapy regimen： cisplatin 20 mg d1 - d5, tegafar 1.0 g d1-d5 and calcium folinate 0. 2 g, d1 -d5, 21 days as a therapeutic coures. RUSULTS： The 1-year local regional control rates for the LCAHR group and the control group were 85.7%（30/35） and 64. 7 % （22/34） respectively, P=0. 043. The 1-year overall survival rates and the disease progression-free survival rates for those of the two groups were 77.2%, 52.9% and 71.5%, 47.1% respectively, P= 0. 035 and 0. 039, respectively. The estimated 2-year survival rates and the disease progression-free survival rates for those of the two groups were 68. 9%, 44. 2% and 60. 0%, 35.3% respectively, P=0. 039 and 0. 040 respectively. Acute radiation esophagitis （Grade 2 and Grade 3） for those of the two groups were 8. 6%（3/35）, 5.7%（2/35） and 8. 8% （3/34）, 5.9% （2/34）, respectively. Acute radiation pneumonitis （Grade 2 and Grade 3） for those of the two groups were 2.9%（1/35）, 0 and 5.9 % （2/34）, 2.9% （1/34）, respectively. CONCLUSIONS： LCAHR regimen may significantly improve local control rate and shortterm survival rate in esophageal cancer patients. Furthermore, the normal tissue complication is not increased significantely.