食管癌三维适形大分割放疗的可行性分析

The feasibility analysis of hypofractionated high-dose three-dimensional conformal radiotherapy in the treatment of esophageal carcinoma

目的评价三维适形大分割放疗在食管癌放射治疗中的近期疗效和放射反应。方法食管癌患者160例，设为适形放疗组69例、常规放疗组91例，分别采用三维适形大分割放疗和常规放疗进行治疗。适形放疗组处方剂量3000～4500eGy，分割剂量300eGy，1次／d，5次／周，照射剂量参考线为90％等剂量曲线。常规放疗组处方剂量4000～6600cGy，分割剂量180—200cGy，1次／d，5次／周。比较2组的近期疗效、生存期，以及放射治疗的副反应。结果适形放疗组完全缓解（CR）为42．0％（29／69），部分缓解（PR）49．3％（34／69），近期有效率91．3％；常规放疗组CR为35．2％（32／91），PR59．3％（54／91），近期有效率94．5％，2组比较差异无统计学意义（x2=1．033，P〉0．05）。1年期生存率分别是82．6％（57／69）与84．6％（77／91），2组比较差异无统计学意义（P〉0．05）。急性放射性食管炎三维适形放疗组发生率为66．7％（46／69），高于常规放疗组64．8％（59／91），但差异无统计学意义（P〉0．05）。结论三维适形大分割放疗用于食管癌治疗是可行的。

Objective To evaluate the instant response and side effects of hypofractionated high-dose 3- dimensional conformal radiotherapy （3-DCRT） for esophageal carcinoma treatment. Methods Sixty-nine patients with esophageal carcinoma were treated by 3-DCRT and 91 patients with routine radiotherapy. The prescribed dose was from 3000 to 4500 cGy in 3-DCRT group, with fractionated dose 300 eGy, one dose a day and five doses a week. The reference dose curve was the 90% of the isodose curve. For the routine radiotherapy group, the prescribed dose was from 4000 to 6600 cGy, fractionated by 180 -200 cGy a time, once a day and 5 times a week. Results At the end of the radiotherapy, 3-DCRT produced CR 42. 0% （ 29/69 ）, PR 49.3 % （34/69） and instant response rate 91.3%, while routine radiotherapy produced CR 35. 2% （32/91）, PR 59.3% （54/91） and instant response rate 94. 5% , respectively. The difference was not significant between the two groups（ P 〉 0.05 ）. The survival rates one year after the treatment were 82. 6.0% （ 57/69 ） and 84. 6% （77/91） ,respectively. The acute radiation esophagitis rate was 66. 7% （46/69） in 3-DCRT group and was 64. 8% （59/91） in routine radiotherapy grouprespeetively. Conclusion Hypofractionated high-dose 3-DCRT is feasible for treatment of esophageal carcinoma.