食管癌三维适形后程加速放疗的临床研究

Late course accelerated three-dimensional conformal radiotherapy for esophageal carcinoma

目的利用三维适形放疗（3DCRT）技术对中晚期食管癌患者进行后程加速照射，对其疗效和副反应进行观察与分析。方法55例首程治疗的食管癌患者接受3DCRT，随机分为3DCRT后程加速组（加速组，27例）和3DCRT常规分割组（常规组，28例），常规组处方剂量64—66Gy分32—33次，加速组处方剂量67～70Gy分29～30次，第5周开始加速照射3Gy／次，5次／周。观察两组患者近期疗效、急性副反应及局部控制率、生存率和死亡原因。结果加速组完全缓解率85％、部分缓解率15％、总有效率100％，常规组的分别为57％、43％、100％，加速组优于常规组（x^2=5．24，P=0．022）。两组1—5年局部控制率相似（x^2=0．68，P=0．409），1～5年生存率也相似（x^2=0．06，P=0．804）。放射性食管炎发生率两组相近（85％：89％；x^2=0．00，P=0．959），加速组放射性肺炎发生率略高于常规组（67％：43％；x^2=3．14，P=0．076）。加速组和常规组死亡分别为19、21例，其中局部控制失败分别为10、15例，远处转移分别为7、5例。结论食管癌3DCRT后程加速放疗近期疗效满意，与3DCRT常规分割放疗相比局部控制率和远期生存率未见明显提高，后程加速照射有可能增加急性放射性肺及食管损伤但临床尚能接量。

Objective To investigate the result and side effect of late course accelerated three-dimensional conformal radiotherapy （3DCRT） for esophageal carcinoma. Methods From July 2003 to March 2006, 55 patients with esophageal carcinoma receiving 3DCRT were randomly divided into late course accelerated radiation group （group A, 27 patients） and conventional fractionation group （group B, 28 patients）. The prescribed dose in group B was 64 -66 Gy, 2 Gy per fraction, 1 fraction per day, 5 fractions per week for about 6.5 weeks. Patients in group A received conventional fractionation irradiation for the first 4 weeks. Then the dose was increased to 3 Gy per fraction to a total dose of 67 - 70 Gy. The treatment course in group A was about 6 weeks. The treatment response, acute site effects, 1-, 3-and 5-year local control rates and o- verall survival rates of the two groups were observed. Results In group A, 23 patients （ 85% ） achieved complete response （CR） and 4 （15%） achieved partial response （PR）. While in group B, 16 patients （57%） achieved CR and 12（43% ） achieved PR. The CR rate was significant higher in group A （x^2 = 5.24,P =0.022）. The 1-, 3-, 5-year local control rates were 85% , 54% , 54% in group A, and 70% , 56% , 33% in group B （x^2= 0.68, P = 0. 409 ） , respectively. The 1 - ,3-,5-year overall survival rates of the two groups were8l%, 37%, 29% and61%, 39%, 23%（x^2=0.06,P=0.804）, respectively. Bothlocal control and overall survival were similar between the two groups. The incidences of acute radiation esophagitis in the two groups were similar （85% vs. 89% ;x^2 = 0.00 ,P = 0.959） , and the incidence of radiation pneumonitis was slightly higher in group A than in group B （67% vs 43% ;x^2 = 3.14,P = 0.076）. By the last follow up, 19 patients in group A and 21 in group B died. Among them, 10 in group A and 15 in group B died of local failure, while 7 in group A and 5 in group B died of metastasis. Conclusions When compared with conventional fractionation 3DCRT, late course accelerated 3DCRT for esophageal carcinoma can achieve better results in clinical response, though not in long-term local control or survival. The incidence of acute radiation esophagitis and pneumonitis is clinically acceptable.