后程加速超分割适形放疗局部晚期食管癌疗效分析

Three Dimensional Conformal Radiotherapy with Late Course Accelerated Hyperfractionated for Local Advanced Esophageal Carcinoma

目的评价局部晚期食管鳞癌适形放疗并后程加速超分割的疗效。方法将82例食管鳞癌患者随机分为两组:常规分割常规照射组(CF)40例,2Gy/次,5次/周,总剂量60～68Gy,30～34分次,6～7周完成。适形放疗加速后超组(CRT)42例,先常规分割照射2Gy/次,5次/周,40Gy/4周;从第5周起行加速超分割放疗1.4Gy/次,2次/天,间隔6h以上,总剂量59.6～68Gy,34～40分次,5～6周完成。结果CRT组和CF组的1、3年局部控制率分别为76.2%、58.6%和66.7%、28.6%;1、3年生存率分别为69.1%、44.3%和48.5%、24.7%。急性放射性损伤两组无显著性差异。结论在局部晚期食管鳞癌放射治疗中采用适形放疗并后程加速超分割较常规放疗能提高局部控制率和生存率,并不增加放射治疗不良反应。

Objective To evaluate the therapeutic effects of three dimensional conformal radiotherapy with late course accelerated hyperfractionated for local advanced esophageal carcinoma. Methods From September 2002 to September 2004, a prospectively randomized trial was carried out on 82 patients with local advanced squamous cell carcinoma of the esophagus which were randomized into two groups：42 in the three dimensional conformal radiotherapy with late course accelerated hyperfractionated（CRT＆LCAHF） group and 40 in the conventional fractionation（CF） group. Patients in the CRT group received radiation at 2.0Gy/F, 5 days per week, 40Gy/20F/4wks, then 1.4Gy/F,twice a day（interval of 6 hrs）, to a total dose of 59.6-68Gy, 5-6wks. Patients in the CF group received conventional fractionation radiotherapy of 2.0Gy per fraction to a total dose of 60N68Gy/30-34F/6-7wks. Results The local control rates at 1 and 3 years were 76.2%, 58.6% in the CRT group and 66.7%, 28.6% in the CF group（P= 0.0139）. The 1 and 3 year survival rates were 69.1%, 44.3% in the CRT group and 48.5%, 24.7% in the CF group （P= 0.0433）. There was no significant differences on acute complications between the two groups（P〉 0.05）. Conclusion For local advanced esophageal carcinoma, three dimensional conformal radiotherapy with late course accelerated hyperfractionated can improve the survival rate and local control rate without increasing complications.