食管癌腔内微波加温合并放疗的剂量研究

The thermal dose analysis on esophageal cancer treated by intraluminal microwave hyperthermia combined with radiation

目的对用腔内微波加温合并体外放疗的５５例食管癌进行了临床热剂量分析，观察Ｔ９０能否作为食管癌腔内微波加温的热剂量。材料与方法１９８６年～１９８８年５５例食管癌用腔内微波加温并体外放疗（ＲＴ＋Ｈ）。放疗采用８ＭＶＸ前后两野对穿，剂量４周４０Ｇｙ，每周５次，每次２Ｇｙ。热疗：９１５ＭＨｚ微波食管腔内辐射器加温，每次４５分钟，每周１～２次，共３～８次。用３个热电偶测量肿瘤表面温度，从温度曲线得出每次的Ｔ２０、Ｔ５０、Ｔ９０值和数次平均值。结果当Ｔ９０在４２℃～４２．９℃，４３℃～４３．９℃和４４℃～４４．９℃时局控率分别为０％，４４．４％和６８．８％。随着Ｔ９０升高局控率也提高，呈Ｓ状曲线。近期疗效显示：疗后Ｘ线Ⅰ级：Ｔ９０≥４３．５℃的病例，局控率６０％，Ｔ９０≥４４℃局控率７８％；Ⅱ级：Ｔ９０≥４３．５℃的局控率为４７％，Ｔ９０≥４４℃的为６７％，显示Ｘ线Ⅰ级又Ｔ９０≥４４℃的预后好。Ｔ９０＜４３℃的３例病人在３年内死亡。Ｔ９０＞４３℃的病例１，３，５年生存率分别是８６．５％（４５／５２）、４６．２％（２４／５２）和２６．９％（１４／５２）。结论食管癌腔内热疗时测量３个点可作为分析热剂量的依据。Ｔ９０作为食?

Purpose To assess the validity of T90in intraluminal microwave hyperthermia for esophageal cancer.Materials and Methods From 1986～1988,55 cases of esophageal cancer were treated with intraluminal microwave hyperthermia(H) combined with radiation (RT+H)。The intracavitary temperature were recorded and analyzed to show whether T90 could be use as the thermal dose.Radiation was given by 8 MVXray with 2Gy /d to a total dose of 40Gy /4weeks.Hyperthermia:915MHz,self-made microwave applicators giving 45min/session and 1～2 session/week for 3～8 sessions. Three thermocouples were attached on the surface of the applicator to measure the temperature of tumor surface .From the temperature curves of T0 and T3,the T2,T50 and T90(modified from Duke's) were obtained.Results The local control(LC) rates were 0%,44% and 69% when the patients with their T90 of 42℃～42.9℃,43℃～43.9℃ and 44.0℃～44.9℃ ,respectively. There was a typical Sshaped curve showing LC probability and T90 value also had a good correlation with the posttreatment barium film findings. The patients with posttreatment Grade Ⅰ barium esophageogram and T90>44℃were with LC rate of 78%. The patients with Grade Ⅱ Xray findings and T90>43.5℃ were with LC rate of 67%.Among 3 patients with the T90<43℃,no one survived at 3 years after treatment. The 1,3 and 5year survival rates for the patients with T90>43℃ were 86.5%(45/52),46.2%(24/52) and 26.9% (14/52), respectively.Conclusion 3 thermocouples can be used to measure the temperature at the surface of the tumor,the data for T90analysis shows that T90 be a good thermodose for intracavitary hyperthermia for esophageal cancer.