3种放疗治疗食管癌近期疗效分析

The clinical therapeutic effect of there kind of radiation therapy for esophagus cancer

目的探讨常规(CF)、三维适形(3DCRT)和调强(IMRT)放疗治疗食管癌的近期疗效及放疗反应。方法选择2006年9月～2008年1月我院收治的食管癌患者中行单纯放疗的患者共149例,其中采用常规放疗68例(CF组),三维适形放疗45例(3DCRT组),调强放疗36例(IMRT组),均采用6MVX线照射,2.0Gy/次,5次/周,总剂量为60～66Gy、分30～33次、40～45d完成,比较3组的近期疗效及放疗反应。结果 CF组、3DCRT组和IMRT组有效率分别为70.6%、91.1%和91.7%。CF组与3DCRT组和IMRT组有效率差异有统计学意义(P<0.05～0.01)。各临床分期近期疗效差异有统计学意义(P<0.01)。3组1年局部控制率分别为55.4%、70.5%和69.4%;3组2年局部控制率分别为30.8%、50.0%和58.3%;3组1年生存率分别为75.4%、84.1%和83.3%;3组2年生存率分别为33.8%、54.6%和58.3%。3DCRT组+IMRT组放射性食管炎发生率较CF组高(P<0.05),放射性肺炎发生率CF组较IMRT组+3DCRT组高(P<0.05),骨髓抑制反应3DCRT组+IMRT组较CF组轻(P<0.05)。结论 3DCRT和IMRT方法能提高食管癌的临床疗效,放射反应均可耐受。

Objective To evaluate the results and side effects in conventional fractionation radiation therapy（CF）,3-dimensional conformal radiation therapy（3DCRT）and intensity modulated radiarion therapy（IMRT）for esophagus cancer.Methods From September 2006to January 2008,68patients with esophagus cancer were treated by conventional fractionation radiotherapy（CF）,during the same interval,another45 patients treated by 3-dimentional conformal radiation therapy（3DCRT）,and another 36patients treated by intensity modulated radiarion therapy（IMRT）,these three groups treated by 6MV X radio wave,one time 2Gy,five time a week,the total were 60～66Gy,finish in 30～33times,the cycle is 40～ 45days.Results The recent effective rate of CF group,3DCRT group,IMRT group,were 70.6%,91.1%,91.7%respectively.There are significant difference between CF group and DCRT group,CF group and IMRT group.The three group 1year local control rate were 55.4%,70.5%,69.4%;three group 2years local control rate were 30.8%,50%,58.3%;three group 1year survival rate were 75.4%,84.1%,83.3%;three group 2years survival rate were 33.8%,54.6%,58.3%.However,in IMRT＋ 3DCRT group,the incidence of acute radiation esophagistis was higher than CF group（P0.05）,and those of hematogenous side effect were lower（P0.05）.in CF group,the incidence of acute radiation pneumonia was higher（P0.05）.Conclusion Compared with conventional fractionation radiotherapy,IMRT＋3DCRT group are able to improve the clinical therapeutic effect of esophageal carcinoma with tolerable acute radiation side effects.