食管癌术前加速超分割放射治疗临床研究

Pre operative accelerated and hyperfractionated radiotherapy for esophageal carcinoma

目的 对食管癌术前加速超分割放射治疗与术前常规分割放射治疗的效果进行比较。方法 经病理证实的直接手术有困难的食管癌２２４ 例，随机分为加速组１０８ 例和常规组１１６ 例。加速组采用３ 野照射技术，每次２ Ｇｙ 每日２ 次，间隔６ ～８ 小时， Ｄ Ｔ４０ Ｇｙ ，２０ 次，２ 周；常规组前、后对穿照射，常规分割方式， Ｄ Ｔ４０ Ｇｙ ，２０ 次，４ 周。放射治疗与手术间隔３ ～４ 周。结果 加速组和常规组１ ，３ ，５ 年生存率分别为８９ ．７ ％ ，６１ ．２ ％ ，４５ ．３ ％ 和７９ ．７ ％ ，４５ ．５ ％ ，２８ ．８ ％ （ Ｐ＝ ０ ．００１） ；手术切除率分别为９８ ．１ ％ 和９７ ．４ ％ ；加速组和常规组术后放射治疗反应分别为轻度占９ ．４ ％ 和３３ ．６ ％ （ Ｐ＝ １ ．５２ ×１０ － ５ ） ，中度占３８ ．７ ％ 和３８ ．９ ％ ，重度占５１ ．９ ％ 和２７ ．４ ％ （ Ｐ＝ ０ ．０００ ２） ；淋巴结转移率分别为１６ ．０ ％和２５ ．７ ％ （ Ｐ＝ ０ ．０８１） 。加速组未增加手术并发症和手术难度及远期放射损伤。结论 术前加速超分割放射治疗较常规分割放射治疗能明显改善食管癌的生存率，而不增加手术难度及并发症。

Objective To improve the treatment results of advanced esophageal carcinoma,preoperative accelerated and hyperfrationated radiotherapy(PAHT) was used and compared with preoperative routine radiotherapy (PRRT). Methods From Mar. 1989 to Nov. 1994,224 patients with esophageal carcinoma were randomized into PAHT group and PRRT group. 108 patients of PAHT group received D T40 Gy, at 2 Gy twice daily, 5 days per week by a three port technique,116 cases of PART received D T 40 Gy at 2 Gy once daily, 5 days per week through AP PA portals. The patients were operated upon 3 to 4 weeks after irradiation.Results The 1 ,3 and 5 year survival rates were 89.7%,61.2%, 45.3% in PAHT and 79.7%,45.5%,28.8% in PRRT group(P=0.001). The resectability rates were 98.1%(106/108) in PAHT and 97.4% (113/116) in PRRT. The radiation responses by histopathology were: grade Ⅰ 9.4%(10/106) in PAHT,33.6% (38/113) in PRRT (P=1.52×10 -5 );grade Ⅱ 38.7%(41/106) in PAHT,38.9%(44/113) in PRRT; grade Ⅲ 51.9%(55/106) in PAHT,27.4%(31/113) in PRRT (P=0.000?2). Mediastinum lymph node metastasis were found in 16.0%(17/106) in PAHT, and 25.7% (29/113) in PRRT (P=0.081). It was not observed that PAHT increased the difficulty of resection, nor did it increase operative complications and late radiation injury.Conclusions Preoperative accelerated and hyperfractionated radiotherapy is able to improve the survival rate of patients with advanced esophageal carcinoma predicted as difficult to resect without increasing operative difficulty or complications.