食管癌不同大小照射野放疗的临床结果及其分析

A CLINICAL TRIAL OF THE RADIOTHERAPY FOR THE MANAGEMENT OF ESOPHAGEAL CARCINOMA BY USING DIFFERENT SIZES OF RADIATION FIELD

目的使用扩大野照射食管癌，企图最大限度消除漏照发生率，从而提高食管癌的放疗疗效。方法对８０例食管癌进行常规野和扩大野放疗随机前瞻性研究。常规组前野６ｃｍ×１５ｃｍ垂直照射，二后斜野５ｃｍ×１５ｃｍ成角照射，每周照射５次，总量７０．２Ｇｙ／３９次共５６天。扩大野组病灶≤５ｃｍ无外侵征象者前野７ｃｍ×１５ｃｍ，二后斜野６ｃｍ×１５ｃｍ，病灶＞５ｃｍ或任何长度有外侵征象者前野８ｃｍ×１５ｃｍ，二后斜野６ｃｍ×１５ｃｍ每周照射５次，４５Ｇｙ／２５次后缩野至１０ｃｍ～１２ｃｍ宽度不变，继续照２５．２Ｇｙ／１４次，总量７０．２Ｇｙ／３９次共５６天。结果常规组１～３年食管癌局部病灶控制率和生存率分别为６２％、４９％、４３％和６２％、４６％、４６％，扩大野组１～３年食管癌局部病灶控制率和生存率分别为８４％、７４％、７４％和７２％、５５％、４９％。扩大野组的局控率明显高于常规组。Ｐ＝０．０１９。生存率两组无明显差异。Ｐ＝０．４１。结论扩大野照射食管癌能明显提高其局控率。

おURPOSE To evaluate the results of different size fields used for management of esophageal carcinoma.METHODS A clinical trail of radiotherapy for the management of a total of 80 patients with esophogeal carcinoma has been done by using two sizes of radiation fields from March 1993 to October 1996.The patients were randomly divided into two groups, treated either by conventional radiation field with an anterior portal 6 cm×15 cm,two posterior oblique portals 5cm×15cm or by larger radiation fields with an anterior portal 7cm×15cm,two posterion oblique portals 6cm×15cm. The radiotherapy was carried out by convertional fraction to total dose of 702 Gy/39 fractions/8 weeks.RESULTS The results showed that patients treated by larger radiation fields had longer 13 year local control (842,737,737% vs 639、486、425%,P=0019) and higher 13 year survival rate than these treated by conventional fields (711,547,489% vs 619、462%、462%,P=041).CONCLUSION The larger radiation field takes advantage over conventional radiation field in terms of local control of esophageal carcinoma.