前程加卡铂后程野中野加速超分割放射治疗食管癌90例临床观察

Clinical observations on 90 patients with esophageal carcinoma treated by radiotherapy of forecourse with adjuvant chemotherapy and late course with accelerated hyperfraction radiotherapy by fieldinfield

目的探讨前程加卡铂后程野中野加速超分割放射治疗食管癌的疗效。材料与方法自１９９１年１０月至１９９３年６月对９０例食管癌病人随机分常规放射治疗组（常规组）和前程加卡铂后程野中野加速超分割放疗组（前化后超组）各４５例。两组临床资料相近，具备可比性。常规组每周照５次，每次２Ｇｙ，总量６０～７０Ｇｙ；前化后超组前３周放疗同常规组，配合卡铂每周两次，每次１００ｍｇ，总量６００ｍｇ。第４，５周在原照射野中设小野（同病变长度），每次１．５Ｇｙ，每周５次，上午照大野，下午照小野，总量５周６５Ｇｙ，其中大野５周５０Ｇｙ，小野后两周１５Ｇｙ。结果放疗结束时Ｘ线改善前化后超组病灶全消和消失１／２以上８６．７％（３９／４５），常规组５７．８％（２６／４５）（Ｐ＜０．０１）。１，２，３，４年生存率分别为７５．６％、５３．３％、４２．２％、３３．３％和５５．６％、３１．１％、２０．０％、１５．６％。前化后超组明显好于常规组（Ｐ＜０．０５）。结论前程配合卡铂后程大野套小野加速超分割放射治疗能显著提高食管癌１，２，３，４年生存率，病人能顺利完成疗程。

Purpose To evaluate the effects of radiotherapy of forecourse with adjuvant chemotherapy and late course of accelerated hyperfraction radiotherapy by fieldinfield for esophagus carcinoma.Materials and Methods From October,1991 to June, 1993, 90 patients with esophagus carcinoma were randomized into two groups: Conventional fraction radiation (CFR) group (45 cases) and fore course combined chemotherapy followed by late course of accelerated hyperfraction radiotherapy by fieldinfield (FCLHR) group (45 cases). The clinical materials of the two groups were similar. Patients in CFR group received 2 Gy/F, 5 fractions/week with the total dose of 60～70 Gy/6～7 weeks. Patients in FCLHR group received 30 Gy/3 weeks in conventional fields , concomitantly with chemotherapy (carboplantin 100 mg/a day iv drip, 2 times/a week with the total dose 600 mg) followed by accelerated hyperfraction irradiation (2 fraction/a day with 4～6 hour interval, 2 Gy/f in large field with total dose of 20 Gy/2 weeks,1.5 Gy/F in small field with 15 Gy/2 weeks) during late 2 weeks of the course. The total dose was 65 Gy/5 weeks in FCLHR.Results The complete response and partial response rates were 86.7% (39/45) in FCLHR group,and 57.8% (26/45) in CFR group, respectively, at the end of the course (P<0.01). The 1,2,3,4year survival rates were 75.6%, 53.3%, 42.2%, 33.3% in FCLHR group and 55.6%, 31.1%, 20.0%, 15.6% in CFR group, respectively (P<0.05).Conclusion The 1,2,3,4year survival rates of patients with esophagus carcinoma can be improved by FCLHR. This treatment method is tolerable.