后程加速超分割三维适形放射治疗食管癌的临床观察

Observation of late-course accelerated hyperfractionated three-dimensional conformal radiotherapy for treatment of esophageal cancer for long-term outcome

目的观察后程加速超分割三维适形放疗(3DCRT)对食管癌的近远期疗效、不良反应及失败原因。方法将126例食管鳞癌患者随机分至后程加速超分割三维适形放疗组(后超组)和后程常规分割三维适形放疗组(对照组)。放疗方法:两组前2/3疗程均为普通模拟机定位常规放疗40Gy,后1/3疗程后超组改为CT模拟定位加速超分割三维适形放疗(1.5Gy/次,24～30Gy,总剂量64～70Gy,36～40次,全疗程38～42d);对照组常规分割三维适形放疗至上述相当剂量。结果后超组和对照组5年生存率分别为34%和15%,后超组生存率显著高于对照组(P=0.029)。后超组中位复发时间也显著长于对照组(11.0、7.0个月,P<0.01)。3、4、5年无瘤生存率分别为36%、34%、32%和19%、16%、15%,后超组无瘤生存率均显著高于对照组(P值均<0.05)。后超组和对照组1、2、3、4、5年局部控制率分别为78%、74%、64%、62%、61%和59%、38%、30%、28%、26%,后超组局部控制率均显著高于对照组(P值均<0.05)。Cox回归分析显示颈段、胸上段食管癌的疗效明显优于胸中段、胸下段食管癌,蕈伞型优于其他类型(P值均<0.01)。结论常规放疗后进行后程加速超分割三维适形放疗可作为颈段、胸上段和蕈伞型食管癌的首选方法之一,它可提高局部控制率和远期生存率,且不会明显增加反应。

Objective To analyze the long-term outcome of esophageal cancer patients treated with late-course accelerated hypeffractionated three-dimensional conformal radiotherapy （LCAF3DCRT）. Methods One hundred and tweenty six esophageal cancer patients were randomly divided into two groups： （1） LCAF3DCRT group-63 patients were treated by conventional fractionated radiotherapy during the first twothirds of the course with 40 Gy for 20 fractions, then followed by hyperfraction 3 DCRT （1.5 Gy per fraction, two times daily a total dose of 64 - 70 Gy in 36 - 40 fractions over 38 - 42 days; （2） Control group-63 patients were treated with the same method during the first two-thirds of the course, but followed by conventional fractionated 3DCRT with the same dose. Results The 5-year survival rate was 34% and 15% in LCAF3DCRT group and control group, respectively （P = 0.029）. The median relapse time was 11.0 and 7.0 months in LCAF3DCRT group and control group, respectively（P 〈 0.01）. The 3-,4-, and 5-year tumor-free survival rate was 36%, 34%, 32% in LCAF3DCRT group and 19%, 16%, 15% in control group, respectively（all P 〈 0.05）. The 1-,2-,3-,4-, and 5-year local control rate was 78%, 74%, 64%, 62%, 61% in LCAF3DCRT group and 59%, 38%, 30%, 28%, 26% in control group, respectively （all P 〈 0.05）. Cox multivariate model indicated that the effectiveness was superior to others if the tumorwas located either in the cervical or upper segment, or was the fungating type（P 〈 0.01）. Conclusion Late-course accelerated hyper-fractionated three-dimensional conformal radiotherapy can be taken as the first choice for esophageal carcinoma in the cervical or upper segment, orthe fungatingtype after conventional fractionated radiotherapy. It can improve the local control and survivalrate.