单纯放疗和放化同期综合治疗急性放射性食管炎的临床研究

The clinical study of acute esophageal toxicity of conventional radiotherapy versus concurrent chemoradiotherapy

目的 探讨胸部肿瘤单纯放射治疗和放化同期综合治疗所引起的急性放射性食管炎的临床症状的严重程度、持续时间及内镜下改变。方法 从2003年1月-2004年10月。共有66例非小细胞肺癌、食管癌病人进入本研究，病人随机分为单纯放疗组（BT）32例，放化同期综合治疗组（RCT）34例。放疗均采用三维适形放疗，常规分割。同期化疗分别采用FP方案、EMV方案。使用多种国际上常用的评价标准，包括RTOG临床评分、内镜评分、食管炎指数，分析两组病人的急性放射性食管损伤的临床症状程度、症状持续时间及内镜下改变的不同。结果 急性放射性食管炎的典型临床症状主要表现为吞咽困难加重、局部疼痛或胸骨后灼烧感。根据RTOG临床评分，二级及二级以上具有临床意义的食管炎和三级及三级以上严重反应的的发生率，RT组为22％、3．1％，RCT组为67．6％、26．4％，RCT组高于RT组具有统计学意义（P〈0．05）。二级和二级以上内镜评分（Kuwaht’s评分），RT组为25％，RCT组为60％，RCT组高于RT组具有统计学意义（P〈0．05）。RT组EI评分平均为13．6，RCT组为52．4，具有统计学意义（P〈0．05）。结论 RCT组的急性放射性食管炎临床症状的严重程度、持续时间、溃疡出现的程度均高于RT组。

Objective To inquire clinical characteristics, endoscopic findings and evaluation of esophagitis induced by radiation therapy for cancer in the thorax on conventional radiotherapy versus concurrent chemoradiotherapy. Methods From October 2003 to March 2005, the 66 patients of lung cancer or esophageal cancer have been randomized to receive radiotherapy alone （RT group） and concurrrent chemoradiotherapy （RCT group）. All patients were treated with 3D - CRT in single daily fractions of 1.8 Gy - 2.0 Gy, the regimens of concurrent ehemotherapy is FP or CMF. Various evaluations on the acute esophagitis including the radiation therapy oneology group criteria, Kuwaht＇ s criteria and esophagitis index were adopted. The clinical characteristics, endoscopic findings of esophagus and esophngitis index （EI） were analyzed between RT group and RCT group. Results The typical symptom included medeate dysphagia or odynophagia and requiring narcotic analgesics. The grade 2 or worse acute esophagitis using RTOG criteria was observed in 22% in RT group and 67.6% in RCT group. The grade 3 and 4 was 3.1% in RT group and 26.4% in RCT group. The grade 2 and 3 acute esophagitis using Kuwaht＇ s criteria was observed in 25% in RT group and 60% in RCT group. The average of esophageal index was 13.6 in RT group and 52.4 in RCT group. Conclusion The degree of the clinical symptom of acute esophagitis, the time of suffering and the tdcerate in esophagus are more severe in RCT group than RT group.