42例放疗后复发食管癌三维适形放疗的疗效分析

Three-dimensional conformal radiotherapy for loco-regionally recurrent esophageal cancer after initial radiotherapy

目的探讨三维适形放疗（3DCRT）在食管癌首程放疗后局部复发患者中应用的可行性、疗效和放射损伤及影响因素。方法42例首程放疗后局部复发的食管癌患者，采用3DCRT技术进行二程放疗。放疗处方剂量中位值54Gy（50～64Gy），1．8～2．0GH次，5次／周。结果随访截至2008年12月31日，随访率为100％，其中随访满1、2年者分别为20、22例。42例患者中完全缓解7例，部分缓解31例，无进展4例。全组患者1、2年总生存率分别为60％和24％。全组≥2级放射性食管炎15例，其中2级13例，3级2例。≥2级放射性肺炎9例，其中2级8例，3级1例。≥2级血液学副反应3例，其中2级2例，3级1例。本组共死亡28例，其中死于局部复发9例、远处转移7例、食管瘘1例、食管狭窄1例、全身衰竭4例、心脏病3例、电解质紊乱1例、死因不明1例。结论食管癌首程放疗后局部复发采用3DCRT二程放疗是可行的，有较好临床症状缓解率和即时疗效，部分患者可延长生存期；但再程放疗并发症较高，临床应用时应严格掌握其适应证。

Objective To evaluate the feasibility, therapeutic effects and normal tissue complications of three-dimensional conformal radiotherapy （3DCRT） for loco-regionally recurrent esophageal cancer after initial radiotherapy. Methods Between March 2001 and May 2007, 42 patients with locoreigonal recurrent esophageal cancer after initial radiotherapy were treated with 3DCRT, including 27 male and 15 female with a median age of 67.5 years. Radiotherapy was delivered at 1.8 - 2.0 Gy per fraction, 5 fractions per week, with a median total dose of 54 Gy. Treatment outcomes and normal tissue complications were assessed with WHO and RTOG/EORTC criteria. Results By December 31, 2008, the follow-up rate was 100%. Twenty patients had follow-up time of 1 year and the remaining 22 had 2 years. The clinical symptom relief rate was 60% , and the response rate was 90.5% with a complete remission rate of 17% and partial remission rate of 74%. The overall 1- and 2-year survival （OS） rates were 60% and 24%. Grade 2 and grade 3 acute radiation esophagi tis developed in 31% and 5% of the patients, respectively. Grade 2 and grade 3 acute radiation pneumonitis developed in 19% and 2% , respectively. Grade 2 and grade 3 acute radiation hematology toxicities developed in 5% and 2%, respectively. Conclusions For patients with loco-regional recurrences of esophageal cancer after initial radiotherapy, 3DCRT is feasible, with a good clinical symptom relief rate and immediate tumor response. However, the complication rate was high and the clinical indications should be strictly controlled.