后程超分割放疗协同不同化疗方案治疗食管癌的临床研究

The clinical research of late course hyperfractionated radiotherapy plus different chemotherapy for esophageal carcinoma

目的评价后程超分割放疗协同不同化疗方案治疗局部晚期食管癌的疗效及不良反应。方法前瞻性研究，入组287例局部晚期食管癌，先采用信封法随机分为后程超分割放疗协同顺铂＋5-氟尿嘧啶（DF）＋甲酰四氢叶酸钙（CF）化疗组（A组）及协同口服5-氟尿嘧啶多相脂质体化疗组（B组），两组中拒绝行化疗者入单纯后程超分割放疗组（C组）。A组115例，B组107例，C组65例。放疗方法：3组前2／3疗程均先常规分割放疗至D，40Gy，然后缩野避开脊髓行等中心超分割放疗，D_T1．3～1．5Gy／次，2次／d，5d／w。总剂量：A、B组DT60～66Gy，C组DT60～70Gy。预防剂量D_T50Gy。结果A、B、C3组近期疗效无统计学差异，1、2、3年肿瘤局部控制率分别为80％、50．4％、42．6％；72．9％、51．4％、41．1％；63．1％、38．5％、30．8％；1、2、3、5年生存率分另4为79．1％、53％、39．1％、27．1％；82．2％、48．6％、37．4％、26．6％；72．3％、38．5％、26．2％、18．6％；其中1年肿瘤局部控制率、3年生存率A组均明显优于C组（X^2=6．16，P〈0．025；X^2=4．67，P〈0．05；）。Ⅱ度及以上骨髓抑制、放射性食管炎、放射性气管炎发生率A、B、C3组分别为50．5％、11．2％、9．2％；50．4％、23．4％、18．5％；33％、12．1％、10．8％。A组均明显高于B、C组（P均〈0．005），B、C组之间差异无统计学意义（P均〉0．05）。结论A组提高了1年肿瘤局部控制率和3年生存率，但Ⅱ度及以上骨髓抑制、放射性食管炎、放射性气管炎发生率均明显增加；B组局部控制率、生存率均有增高趋势，与A组差异无统计学意义，且无严重不良反应，患者耐受性良好；病例数量尚较少，需进一步研究。

Objective To evaluate the treatment resuhs and side-reactions of esophageal carcinoma with late course hyperfractionated radiotherapy （LCHR） plus different chemotherapy. Methods A prospective research was carried out on 287 advanced stage esophageal carcinoma patients whom were randomized into there groups ： LCHR ＋ cisplatin ＋ 5- fluorouracil ＋ leucovorin group（ A group）, LCHR ＋ 5- fluorouracil polyphase liposome group （B group） and LCHR group（C group）. 115 patients were in A group and 107 patients in B group and 65 patients in C group. Radiotherapy method：there groups were treated by conventional fractionated radiotherapy during the first two-thirds of the whole course with 40 Gy, then followed by isocenter hyperfraetionated radiotherapy to keep away of spinal marrow,1.3-1.5Gy per time,2 times a day and 5 days a week. The total dose was 60-66 Gy in A, B group and 60-70 Gy in C group. The preventive dose was 50 Gy. Results There was no statistically difference among the there groups on the short-term curative effect. The 1- ,2- ,3-year local control rate was 80%, 50. 4%, 42. 6% and 72. 9%, 51.4%, 41.1% and 63. 1%, 38.5 %, 30. 8% in there groups. The 1-,2-,3-,5-year survival rate was 79. 1% ,53% ,39. 1% ,27. 1% and 82. 2% ,48. 6% ,37.4%, 26. 6% and 72. 3% ,38.5% ,26. 2% ,18. 6% in there groups. The 1-year local control rate and 3-year survival rate in A group were higher than those of C group （X^2 =6. 16 ,P 〈0. 025 ;X^2 =4. 67 ,P 〈0. 05 ）. The incidence rates of Ⅱ°and above myelosuppression ,radioactive esophagitis, radioactive tracheitis were respectively 50. 5%, 11.2%, 9. 2% and 50. 4%, 23.4%, 18. 5 % and 33 %, 12. 1%, 10. 8 % in A, B and C group. Ⅱ° and above myelosuppression,radioactive esophagitis, radioactive tracheitis in A group were higher than those of B and C groups （ P 〈 0. 005）. There was no statistically difference between B and C group （ P 〉 0. 05 ）. Conclusion The 1-year local control rate and 3-year survival rate were improved in A group. But the incidence rates of Ⅱ° and above myelosuppression, radioactive esophagitis, radioactive tracheitis were raised evidently. The local control rate and survival rate in B group were higher than those in C group with better toleration and no severe side effect, but there was no statistically difference from A group. Further study should be carried out with more cases.