食管癌三维适形加^(252)Cf中子放疗并化疗的临床分析

Clinical Analysis of Three Dimensional Suitable Shape Combined with the ^(252)Cf Neutron Cavity Radiotherapy in Esophagus Cancer

目的观察252Cf中子腔内加三维适形放疗结合同步化疗治疗不能手术的中晚期食管癌的近期临床疗效。方法对48例未接受过任何治疗的不能手术的中晚期食管癌作为研究对象,化疗采用顺铂30mg/第d1￣5天静脉推注,5-氟脲嘧啶750mg/d1￣5天静脉点滴,21￣28d为1周期,共用2￣3周期;1周期化疗在放疗开始当天开始,放疗外照射采用体外三维适形放疗,GTVDT:52～62GY左右;期间配合252Cf中子腔内后装治疗,参考点剂量为4GY/次,使总剂量达8～16GY/2～4次,中子腔内后装治疗单日不行外照射治疗。结果近期疗效,所有病例在治疗结束后3个月、6个月复查食管MRI结果示仅2例未控,其余皆达到CR,所有患者均出现不同程度的放射性食管炎,无一例出现放疗中及放疗后食管穿孔,消化道反应的发生率为93.7%(45/48),骨髓抑制的发生率为83.3%(40/48),无严重肝、肾损伤。放化疗所引起的胃肠反应及骨髓抑制,经积极对症处理后未影响治疗。结论252Cf中子腔内加三维适形放疗结合同步化疗治疗中晚期食管癌,可提高局控,改善生活质量,且无严重不良反应,应作为不能手术的中晚期食管癌的主要治疗手段。

Objective To observe the short-term clinical curative effect of ^252Cf neutron cavity and three dimensional suitable shape radiotherapy union synchronization chemotherapy in treatment of late stage esophagus cancer. Methods 48 examples mid and late stage esophagus cancer were taken as the subject of the study, the chemotherapy used along platinum （DDP） 30mg/the d1-5 day vein pushes the note, 5- fluorine urea pyrimidine （5-Fu） 750mg/d1-5 day vein intravenous drip,21-28 days was one cycle, used for 2 - 3 cycles; The radiotherapy external irradiation used in vitro three dimensional suitable shape radiotherapy,about GTVDT：52-62GY; Period coordinated in the ^252Cf neutron cavity the breech loading treatment,the reference point dosage was 4GY/time, caused the integral dose to reach about the 8- 16GY/2-4 time. Results In the near future curative effect, all cases after the treatment had ended 3 months,6 month reexamination esophagus MRI result showed the only 2 examples not to control, other all achieve CR, all patients presented the varying degree the radioactive esophagitis,after not having 1 example presents in the radiotherapy and the radiotherapy,esophagus perforation,not serious liver,kidney damage, the stomach and intestines which caused by the chemotherapy was the marrow suppresses,after positive treatment,the illness processing had not been affected. Conclusion In the ^252Cf neutron cavity combine with the three dimensional suitable shape radiotherapyin treatment of mid and late stage esophagus cancer,may enhance the bureau to control,improve quality of life, and not serious untoward effect, should be as the amin treatment method for cancer.