食管癌全程三维适形放射治疗的临床研究

Whole three-dimensional conformal radiotherapy for esophageal carcinoma

目的:探讨食管癌全程三维适形放射治疗(3DCRT)结合后程加速超分割放射治疗的疗效及放疗毒副反应。方法:将98例食管鳞癌患者随机分为观察组和对照组,观察组(48例)全程行3DCRT,先常规分割照射,2Gy/次,5次/周,30～36Gy后改为加速超分割放疗,1.3Gy/次,2次/d,总剂量60～66Gy,6～6.5周完成。对照组(50例)常规放疗,2Gy/次,5次/周,总剂量60～70Gy,6～7周完成。观察两组患者的临床疗效、放疗毒副反应。结果:1、2、3年原发肿瘤的局部控制率和生存率与对照组比较,观察组明显提高,分别为87.5%、70.8%、58.3%比60.0%、42.0%、32.0%和89.6%、68.8%、56.3%比58.0%、44.0%、26.0%,差异均有统计学意义,P值均<0.05;观察组急性放射反应发生率与对照组比较略高,但两组差异无统计学意义,P>0.05。结论:全程3DCRT结合后程加速超分割放疗治疗食管癌的疗效优于常规放射治疗,并且放射性毒性可耐受。

OBJECTIVE：To evaluate the therapeutic effect and safety of whole three-dimensional conformal radiotherapy （3DCRT） combined with late course accelerated fractionation radiotherapy （LCAFR） on patients with esophageal carcinoma. METHODS： Ninty-eight cases with esophageal carcinoma were randomly divided into an observing and a control group. The patients in the observing group （48 cases）were treated by whole 3DCRT,in 2 Gy/f,5 fractions/w,to a dose of DT 30-36 Gy,then 1.3 Gy/f,twice a day to a total dose of DT 60-66 Gy/（6-6.5）w. The patients in the control group（50 cases） were treated by conventional radiotherapy in 2 Gy/f,5 fractions/w,to a total dose of DT 60-70 Gy/（6-7）w. The clinical efficacy and radiation toxicities were compared between the two groups. RESULTS： The 1,2 and 3 year tumor local and survival rates in the observing group significantly improved compared with the control group,being 87. 5%,70. 8%,58. 3%,vs 60.0%,42. 0%,32.0% and 89. 6%,68.8%,56.3% vs 58.0%,44. 0%,26.0%,respectively（P〈0.05）. The side effects increased in the observing group,but there was no significiant difference between the two groups（P〉0.05）. CONCLUSION： The therapeutic effect of whole course 3DCRT combined with LCAFR for esophageal carcinoma is superior to conventional radiotherapy,and radiation toxicities could be endured.