食管癌三维适形放疗分割方式研究

An Analys is on Time-dosage Fractionation of 3DCRT for Esophageal Cancer

[目的]探讨食管癌三维适形放疗三种时间—剂量分割方式的疗效及副反应。[方法]选择未经治疗的食管癌患者169例,随机分为A(2Gy/次,5次/周,共30～33次)、B(2.5Gy/次,5次/周,共21～23次)和C(3.0Gy/次,5次/周,共16～18次)组,总剂量DT60～66Gy,中位剂量64Gy。[结果]近期有效率A组、B组和C组相似(95%、96%、95%,χ2=2.33,P=0.350);完全缓解率三组亦无显著差异(75%、80%、77%,χ2=0.91,P=0.630)。3年生存率B组最高(36%、57%、39%,χ2=6.13,P=0.047);3年局部控制率B组亦较高(36%、57%、51%,χ2=5.42,P=0.067)。早期2、3级放射性食管炎(27%、36%、52%,χ2=7.01,P=0.030,4%、9%、21%,χ2=7.60,P=0.023)和放射性肺炎(16%、27%、37%,χ2=6.23,P=0.041,0、4%、9%,χ2=5.54,P=0.064)发生率C组最高;晚期2、3级放射性食管炎C组最高(13%、18%、32%,χ2=6.68,P=0.037;4%、9%、18%,χ2=6.25,P=0.040);3级晚期放射性肺炎发生率C组亦最高(0、5%、11%,χ2=6.21,P=0.041)。[结论]常规2.5Gy/次,5次/周分割方式比常规分割治疗效果好,副反应可接受,可考虑作为三维适形放疗食管癌的治疗模式。

[Purpose]To study the curative effect and side effect by three types of time-dosage fractionation of 3DCRT for esophageal cancer.[Methods]One hundred and sixty-nine untreated esophageal cancer patients were divided into 3 groups：group A,2.0Gy per time,5 times per week and 30～33 times in total;group B,2.5Gy per time,5 times per week and 21～23 times in total;and group C,3.0Gy per time,5 times per week and 16～18 times in total,with DT60～66Gy and median 64Gy dose in every groups.[Results]No significant difference was found either short-term response（95%,96%,95% respectively,χ2=2.33,P=0.350）or complete response（75%,80%,77% respectively,χ2=0.91,P=0.630）in group A,B and C.The 3-year survival in group B was the highest in the 3 groups（36%,57%,39%respectively,χ2=6.13,P=0.047）,as also to the 3-year local control rate（36%,57%,51%,χ2=5.42,P=0.067）.The incidence of early radiation esophagitis（grade 2,grade 3）（27%,36%,52%,χ2=7.01,P=0.030;4%,9%,21%,χ2=7.60,P=0.023）and radiation bronchitis（grade 2,grade 3）（16%,27%,37%,χ2=6.23,P=0.041;0,4%,9%,χ2=5.54,P=0.064）was highest in group C.In group C,the incidence of advanced radiation esophagitis grade 2 and grade 3 was higher than that in the other two groups（13%,18%,32%,χ2=6.68,P=0.037,4%,9%,18%,χ2=6.25,P=0.040）.The incidence of advanced radiation bronchitis grade 3 was also the highest in 3 groups（0,5%,11%,χ2=6.21,P=0.041）.[Conclusions]The curative effect of radiotherapy with 2.5Gy per time,5 times per week,is better than that of conventional radiotherapy,and the side effect is tolerable,and it could be the treatment model of the 3DCRT for esophageal cancer.