外照射配合^(252)锎中子射线腔内照射治疗食管癌的临床观察

A Clinical Observation of Cf-252 Intracavitary Radiation Combined with External-beam Irradiation in the Treatment of Esophageal Carcinoma

目的观察外照射与252锎中子射线内照射结合治疗食管癌的疗效及不良反应。方法对50例局部中晚期食管癌初治患者进行前瞻性随机分组研究。大分割组:外照射40 Gy后,开始内外照射同期进行,每周六加一次内照射,内照射5 Gy/次,1次/周,共10 Gy/2次;小分割组:外照射30 Gy后,即开始内外照射同期进行,每次3.5 Gy,1次/周,共10.5 Gy/3次。两组外照射总量均为50 Gy,均采用常规分割照射,2 Gy/次,1次/日,5次/周。结果大、小分割组1、3、5年局控率分别为72.73%、58.18%、48.48%和77.52%、46.96%、41.74%(P=0.622),1、3、5年生存率分别为81.82%、40.91%、27.27%和75.00%、32.14%、28.57%(P=0.92);大、小分割组急性放射性食管炎发生率分别为90.90%和92.90%(P=0.80),晚期放射性食管炎发生率分别为81.80%和50.00%(P=0.02)。结论两组局控率及生存率相当,但大分割组晚期放射性食管炎发生率明显高于小分割组。

Objective This study is to evaluate the therapeutic efficacy and the untoward reaction external-beam irradiation combined with Cf-252 intracavitary radiation in the treatment of esophageal carcinoma in a clinical randomized trial.Methods Fifty patients of locally moderate and advanced esophageal carcinoma were randomized into two groups：external beam combined with Cf-252 intracavitary twice group（EBIR-2） and external beam combined with Cf-252 intracavitary three times group（EBIR-3）.In EBIR-2 group,22 patients were first treated with conventional fractionated radiation to a dose of 40 Gy over 4 weeks,then with external and intracavitary radiation concomitantly（5.0 Gy per fraction,once a week to 10 Gy in 2 fractions）.The total dose of external irradiation was 50 Gy.In EBIR-3 group,28 patients were first treated with conventional fractionated radiation to a dose of 30Gy over 3 weeks,then with external and intracavitary radiation concomitantly（3.5 Gy per fraction,once a week to 10.5Gy in 3 fractions）,and the total dose of external irradiation also was 50 Gy.Results The 1-,3-and 5-year local control rate were 72.73%、58.18%、48.48% and 77.52%、46.96%、41.74% in EBIR-2 group and EBIR-3 group,respectively.The 1-,3-and 5-year survival rates were 81.82%、40.91%、27.27% in EBIR-2 group and 75.0%、32.14%、28.57% in EBIR-3 group.Higher acute esophagitis rate was observed both in EBIR-2 and EBIR-3 group,and the rate was 90.9% and 92.9%,respectively.Late esophagitis rate was 81.8% and 50.0% in EBIR-2 and EBIR-3 group.Conclusion The survival rate and local control rate were similar in two groups.But the late effect in EBIR-2 group was higher than EBIR-3 group.