170例食管癌患者放射治疗疗效分析

Effects of Different Radiotherapy Techniques on 170 Cases with Esophageal Carcinoma

目的:回顾性分析食管癌三种不同放射治疗方式的疗效和放疗毒副反应,为中晚期食管癌根治性放疗提供参考方案。方法:对170例符合入组条件的食管癌三维适形放疗(3D-CRT)、后程加速超分割放疗(LCAF)及常规分割放疗(CF)的患者的生存率采用Kaplan Meier法进行生存分析,并用Logrank法进行显著性检验;组间比较采用χ2检验;并采用Cox逐步回归模型进行多因素分析,评估独立预后因素。结果:3D-CRT组1、2、3年局控率及生存率均较CF组高,且差异有显著性(P<0.05)。LCAF组1、2、3年局控率及生存率均较CF组高,但差异无显著性(P>0.05)。3D-CRT组放射性食管炎发生率与CF组相似,放射性肺炎发生率低于后者,但无统计学意义(P=0.260)。LCAF组放射性食管炎及放射性肺炎发生率均高于CF组,但差异均无显著性(P>0.05)。结论:食管癌三维适形放疗及后程加速超分割放疗的局控率、近期生存率优于常规放疗,但三维适形放疗优越性更明显且其毒副反应更轻。

The effects of 3-dimensional eonformal radiotherapy （3D-CRT）, late course accelerated hypeffraetion radiotherapy （LCAF） and conventional radiotherapy （CF） on esophageal carcinoma were retrospectively reviewed. Methods： Data from 170 patients with esophageal carcinoma treated between October 2000 and March 2003 were collected and the patients were divided into three groups according to the radiotherapy received. Kaplan-Meier survival analysis, Log-rank test and X2 test were used to evaluate the effects and side effects of the different radiotherapies. The factors related to tile prognosis were analyzed by COX multivariate analysis. Results： The 1-, 2-, and 3-year local control rates aM survival rates in the 3D-CRT group were 88.1%, 79.0%, 74.4% and 76.9%, 53.9%, 44.9% compared to 79.8%, 57.5%, 37.4% and 72.0%, 36.0%, 24.6% in the CF group （P〈0.05）. There was no significant difference in the 1-, 2-, and 3-year local control rates and survival rates between the LCAF group and the CF group （P〉0.05）. In the 3D-CRT group, the incidence of radiation-induced esophagitis was similar to that seen in the CF group （24.6% vs. 24.0%）, but the rate of radiation-induced pneumonitis was lower than that observed in the CF group （12.3% vs. 20.0%, P=0.260）. There was no significant difference in the incidence rate of radiation-induced esophagitis and pneumonitis between the LCAF group and the CF group （P〉0.05）. Conclusion： 3D-CRT and LCAF have superior effects on patients with esophageal carcinoma than those of CF. And with fewer side effects, 3D-CRT is a superior option in the radiotherapy of esophageal Carcinoma.