食管鳞癌患者同步加量动态调强放疗的疗效观察

Clinical Analysis of 65 Patients with Esophagus Carcinoma Using Dynamic Intensity Modulated Radiotherapy with simultaneous Boost Dose

目的：观察食管鳞癌患者同步加量动态调强放疗疗效。方法：回顾分析2007-2010年收治的中晚期食管鳞癌患者65例。放疗采用10 MV X线同步加量调强放疗方法（在5个射野方向上优化）,1次/d,5次/周,总剂量GTV66 Gy、PGTV60 Gy、PTV54 Gy,5.5-6.0周完成。结果：近期疗效分级1级33例、2级24例、3级8例、4级0例,随访率为98%。65例患者中28例疗后失败,其中局部复发12例,远处转移16例。1、2年总局部控制率分别为85%、77%,近期疗效分级（1＋2）级者的分别为89%、78%,（3＋4）级者的分别为75%、65%（χ^2=6.72,P〈0.05）。1、2年总生存率分别为72%、61%,近期疗效分级（1＋2）级者的分别为81%、68%,（3＋4）级者的分别为66%、57%（χ^2=5.63,P〈0.05）。1、2级放射性食管炎发生率分别为34%、20%。放射性肺炎、血液系统及全身反应较轻,其中血细胞减少1、2级分别为3例、2例,疲乏、纳差、恶心、呕吐分别为1例、3例、2例、1例。结论：中晚期食管鳞癌患者同步加量动态调强放疗疗效比常规放疗和三维适形放疗有不同程度提高且副反应明显下降,近期反应分级（1＋2）级者预后好、（3＋4）级者预后差。

Objective：To observe treatment outcomes of esophagus squamous eell carcinoma using dynamic intensity modufated radiotherapy with simultaneous boost dose.Methods： From 2007 to 2010,65 patients with middle and afternoon esophagus carcinoma were treated by dynamic intensity modulated radiotherapy with simultaneous boost dose.Among 65 patients.All patients were treated by 10 MV X—ray irradiation in GTV 66 Gy.PGTV 60 Gy and PTV 54 Gy on 5.5～6.0 weeks.The optimizing treatment planning was used on five patrol but 1 fraction per day and 5 fraction per week.Results：The early grade of effect were 1 grade 33 patients,2 grade 24 patients 3 grade 8 patients and 4 grade 0 patients.The follow-up rate was 98%.Among 65 patients,28 patients were defeated including 10 patients local recurrence and 16 patients metastasis.The 1 and 2 year overall local control rate were 85%and 77%,with 89%and 78%at 1＋2 grade and 75%and 65%at 3＋4 grade in early grade of effect（χ^2=6.72,P〈0.05）.The 1 and 2 year overall survival rate were 72%and 61%,with 81%and 68%at l＋2 grade and 66%and 57%at 3＋4 grade in early grade of effect（χ^2=5.63,P〈0.05）.The l and 2 grade radiation-induce esophagitis occurring rate were 34%and 20%.Radiation-induee pneumonia,blood cell and B symptoms were light,among lower blood corpuscleat 1 and 2 grade with 3 and 2 patients,inertia with 1 patient,dyspepsia with 3 patients,nausea with 2 patients and vomiting with 1 patient.Conclusion：The treatment outcome of esophagus squamous eell carcinoma using dynamic intensity moduated radiotherapy with simultaneous boost dose are increased differently comparing with conventional radiotherapy and three-dimensional conformal radiotherapy hut side-response are deceased distinctly.The prognosis of 3＋4 grade are better than 1＋2 grade in early grade of effect.