同期化疗并后程加速超分割适形放疗食管癌的临床研究

Clinical Study of a Combination Regimen with Late Course Accelerated Hyperfractionated Comformal Radiotherapy and Concurrent Chemotherapy in Esophageal Carcinoma

目的观察同期化疗并后程加速超分割适形放疗对食管癌的疗效、耐受性和毒副反应。方法选择病变长度≤12 cm、无远处转移的中晚期食管鳞癌患者80例,随机分同期化疗加后程加速超分割放疗组(后加放化组)40例和同期化疗常规分割放射治疗组(普通放化组)40例。两组化疗方案相同:放疗前和第3～4周给予顺铂30 mg/m2,d1～d3;5-氟尿嘧啶500 mg/m2,d1～d5;亚叶酸钙0.2 mld,1～d5,化疗2周期。普通放化组常规设野照射,放射治疗40 Gy左右改野,总剂量DT 64～70 Gy,共32～35次,全疗程35～45 d。后加放化组三维适形放疗常规分割照射DT 30～36 Gy后,改为加速超分割适形照射1,.5 Gy/次2,次/d,照射量34～36 Gy,总剂量为DT66～70 Gy,全疗程35～42 d。结果后加放化组1年、2年、3年、4年生存率分别为69.5%、55.8%、43.7%和38.9%,高于普通放化组的55.0%、39.7%2、8.4%和22.1%(P<0.05);后加放化组1年2、年3、年、4年的局部控制率分别为72.0%6、2.6%5、9.1%、55.2%,稍高于普通放化组的64.6%、50.5%4、7.1%3、9.4%,但差异无统计学意义(P>0.05)。普通放化组Ⅲ级、Ⅳ级食管炎发生率低于后加放化组(P<0.01)。两组急性放射性气管炎、白细胞下降和放射性肺纤维化发生强度差异均无统计学意义(P>0.05)。结论同期化疗加后程加速超分割适形放疗治疗食管癌可提高患者生存率,但Ⅲ度、Ⅳ度急性食管炎发生率明显增多。

Objective To analyze the curative effect,tolerance and toxic side effects of late course accelerated hyperfractionation three-dimensional eonformal radiotherapy（LCAH-3DCRT） combined with concurrent chemotherapy in patients with esophageal carcinoma. Methods Eighty patients with advance esophageal squamous cell were divided randomly into two groups：conventional radio-chemotherapy group（CRC group）and LCAH group,all of this patients didnt have distant metastasis and it＇s lesion extent were less than or equal to 12 cm. Patients in both groups were given 2 cycle chemotherapy before irradiation and 3 to 4 weeks after initiation of irradiation,respectively. The regimen was as follows ：DDP 30 mg/mE at day 1 to day 3,5-Fu 500 mg/m2 at day 1 to day 5,calcium folinate 0.2 ml at day 1 to day 5. Patients in CRC group were treated with conventional fractionation radiotherapy to a dose of 40 Gy,followed by a total dose of 64 - 70 Gy by reduced radiation field in 30 -36 fractions over 35 -45 days. Patients in LCAH group were initiated with a conventional irradiation to a dose about 30 -36 Gy,which was then followed by accelerated hyperfractionation irradiation ,twice dally at 1.5 Gy per fraction with a dose about 34 - 36 Gy, resulting in a total dose about 66 - 70 Gy over 35 - 42 days. Results The 1 - ,2 - ,3 - ,4 -year overall survival was 69.5% ,55.8% ,43.7% ,38.9% respectively for LCAH group,while in CRC group were 55.0% ,39.7%, 28.4% ,22. 1%, respectively, the difference was significant （P 〈 0.05 ）. The 1 -, 2 - ,3 - ,4 - year local control rate were 72.0% ,62.6% ,59.1% ,55.2% respectively for LCAH group ,while in CRC group were 64.6%, 50.5 % ,47.1%, 39.4%, respectively, the difference was not significant （ P 〉 0.05 ）. The rate of Ill-IV esophagitis in LCAH group was higher than that in CRC group（P 〈0.01 ）. The difference of occurrences of the radiation-induced acute bronchitis ,leukocyte decrease and pulmonary fibrosis were not statistical significant（P 〉0.05 ）. Conclusion Combination of LCAH-3DCRT and concurrent chemotherapy can improve overall survival of esophageal carcinoma,but may increase the risk of III -IV esophagitis.