后程加速超分割放射治疗食管癌

Treatment of Esophageal Carcinoma by Late-course Accelerated Hyperfractionation Radiotherapy

目的探讨后程加速超分割放射治疗食管癌的临床疗效和不良反应。方法将120例食管癌随机分为后程加速超分割组(后超组)和常规组,每组60例。所有病例病理诊断明确、均为鳞癌。采用60Co常规3个野照射,常规组2.0Gy/次、1次/d,5次/周,总剂量70Gy,35分次,7周完成;后超组前程2.0Gy/次、1次/d,5次/周,剂量达40Gy后改为1.5Gy/次,2次/d,间隔6h以上,10次/周,总剂量为70Gy,40分次,6周完成。结果随访率为100%。1、3、5年生存率后超组为81.6%、45%、28.3%,常规组为61.6%、23.3%、10%。后超组明显好于常规组(P<0.05)。两组放疗不良反应无差别,其主要死亡原因为局部复发,其次为出血、穿孔及远处转移。结论后程加速超分割能明显提高食管癌患者1、3、5年生存率,不增加放疗不良反应及并发症。

Objective To investigate the efficacy and diverse response of the treatment of esophageal carcinoma by late - course accelerated hyperfractionation （LCAH） radiotherapy. Methods All 120 cases with esophageal cancer were randomly divided into the late - course accelerated hyperfractionation group（ LCAH group） and the conventional group, each containing 60 cases. The pathogenic diagnosis for all the cases were clear, all being with squamous cancer. All of them received conventional ^60Co three-field radiation. The cases in the conventional group underwent 2.0Gy/lf, 1f/d,5f/week ,total doses reached 70Gy by 35 times ,which should be finished within 7 weeks. And the cases in the LCAH group experienced 2.0Gy/lf, 1f/d ,5f/week for the first part of treatment course. When total quantity of 40Gy was reached,it should be changed into 1.5Gy/1f,2f/d,interval period over 6 hours, 10f/week. Total doses came to 70Gy by 40 times, which should be over within 6 weeks. Results The follow-up rates were 100%. The survival rates for 1,3 and 5 years were 81.6% ,45% and 28.3% respectively in the LCAH group. And those in the conventional group were 61.6% ,23. 3% and 10% respectively. The LCAH group was better than the conventional group（ P 〈0.05）. There was no difference of adverse response between the two groups. Their major causes of death were due to local relapse, next due to hemarrage,perforation and remote metastasis. Conclusion The late - course accelerated hyperfractionation radiotherapy can obviously improve the survival rates of 1,3 and 5 years for the cases with esophageal cancer,and also do not increase adverse responses and complications.