简单调强放射治疗与同期化疗治疗颈及胸上段食管癌可行性研究及近期疗效分析

Feasibility and short-term efficacy of simplified intensity-modulated radiotherapy and concurrent chemotherapy for neck and upper thoracic esophageal carcinoma

背景与目的:对于颈及胸上段食管癌,三维适形放疗(3-dimensional conformal radiation therapy,3D-CRT)并不一定都能满足临床要求,而适形调强放射治疗(intensity modulation radiation therapy,IMRT)又会占用大量的人力物力。中国医学科学院肿瘤医院定义了一种简单调强放疗技术(simplified IMRT,sIMRT)。本研究中我们应用sIMRT联合同期化疗治疗颈及胸上段食管癌,并分析急性放射反应和近期疗效。方法:对30例颈及胸上段食管癌的原发灶和预防照射区进行sIMRT计划设计。定义2个靶区:PTV1,给予64Gy(2.13Gy×30次)的照射;PTV2,给予54Gy(1.8Gy×30次)的剂量,设计等角度5野sIMRT计划。在开始放疗的第1～5天和第29～33天给予顺铂(DDP)+氟尿嘧啶(5-FU)方案同期化疗2个周期,放疗结束后28天原方案重复2个疗程。结果:患者可在6周内完成治疗计划,5野sIMRT获得了满意的剂量分布,剂量分布和IMRT相似,但明显优于3D-CRT。所有患者完成了治疗计划,治疗中仅1例发生Ⅲ级放射性气管炎,无因放疗反应而中断治疗的患者。食管病灶达完全缓解(complete remission,CR)者27例(90%),部分缓解(partial remission,PR)3例(10%),总有效率达100%;淋巴结病灶达CR者13例,PR4例。毒性反应主要为Ⅰ～Ⅱ级白细胞下降。结论:sIMRT较复杂调强计划治疗颈胸上段食管癌剂量分布相似,明显优于3D-CRT,近期疗效满意,急性放射反应可耐受,远期疗效及组织损伤尚有待长期随访观察。

Background and Objective= For neck and upper thoracic esophageal carcinoma, three dimensional conformal radiation therapy （3D- CRT） does not necessarily meet all clinical requirements while intensity modulated radiation therapy （IMRT） may take up a lot of labour power and material resources. This study was to explore the feasibility of simplified IMPT （slMRT） and concurrent chemotherapy for neck and upper thoracic esophageal carcinoma, and to investigate the acute toxicities and short-term efficacy of this treatment modality. Methods. sIMRT plans were designed for 30 patients with neck and upper thoracic esophageal carcinoma. Two target volumes were defined. PTVl, which was designed to irradiate to 64 Gy （2.13 Gy x 30 fractions）; PTV2, which was given to 54 Gy （1.8 Gy × 30）. The slMRT plan included five equiangular coplanar beams. All patients concurrently received DDP＋5-FU regimen with radiotherapy on dl-5 and d29-33. Chemotherapy was repeated for two cycles 28 days after radiotherapy. Results： The treatment was completed for all patients within 6 weeks, and only one patient had Grade 3 acute bronchitis. The complete response （CR） rate was 90.0% （27/30） and the partial response （PR） rate 10.0% （3/30）. Overall response was 100% for esophageal lesions and the CR rate 76.5% （13/17）. The PR rate was 23.5% （4/17） in lymph node lesions. The major toxicities observed were Grades Ⅰ-Ⅱ leukocytopenia. Conclusions： slMRT can generate desirable dose distribution for neck and upper thoracic esophageal carcinoma, which is similar to sophisticated IMRT but obviously better than 3D-CRT. The short-term efficacy of slMRT is satisfactory and its acute toxicities are tolerable.