影像学凶型食管癌后程加速超分割放疗联合化疗的临床研究

Clinical Observation of Late Course Accelerated Hyperfractionated Radiotherapy Combined with Chemotherapy on Bad X-ray Esophageal Carcinoma

目的探讨对放疗前影像学凶型食管癌行后程加速超分割放疗(LCAF)加化疗的疗效。方法对76例食管癌患者先采用PF方案化疗1个周期(DDP25mg/m2d1～3,5-FU500mg/m2d1～5,CF200mg/m2d1～5),化疗结束后即行放疗。用8MV-X线,先前后野对穿等中心照射,每次DT2Gy,每周5次,至DT40Gy/20次,共4周。随机数字法分为LCAF组和LCAF+C组。LCAF组缩野后行加速超分割放疗,1.5Gy/次,2次/日,间隔6h,每周5次,剂量:24～27Gy/16～18次,总放疗剂量达64～67Gy/36～38次,5.6～5.8周。LCAF+C组放疗方法同LCAF组,并同时行化疗,方案同第一周期。结果 LCAF组CR+PR为86.8%,LCAF+C组为94.7%。第1、2、3年局控率LCAF组分别为64.7%、52.9%、35.3%;LCAF+C组分别为67.6%、58.8%、44.1%。第1、2、3年生存率LCAF组分别为55.9%、29.4%、23.5%;LCAF+C组分别为61.7%、35.3%、32.3%。两组放射性食管炎发生率Ⅰ+Ⅱ级分别是50%、58.8%,Ⅲ以上分别是11.7%、17.6%。两组相比差异有显著性(χ2=6.05,P=0.034)。结论 LCAF+C组较LCAF组提高了3年局控率(35.3%VS44.1%,P<0.05)和生存率(23.5%VS32.3%,P<0.05),远处转移率有下降趋势(P=0.054)。

Objective To discuss the effect of Late course accelerated hyperfractionated radiotherapy combined with chemotherapy on bad X-ray esophageal carcinoma. Methods 76 patients with esophageal cancer receive chemotherapy with one cycle（DDP 25mg/m2 d1-3,5-FU 500mg/m2 d1-5, CF 200mg/m2 d1-5）,the end of chemotherapy after radiotherapy.By 8MV-X line,first,through such centers around the field of irradiation,each DT2Gy,5 times a week,to DT40Gy/20 times,for 4weeks.Randomly divided into LCAFgroup and LCAF＋Cgroup.Reduced fields LCAF group underwent hyperfractionated accelerated radiotherapy, each DT1.5Gy, 2times a day,5 times a week, to DT24-27Gy/16-18 times, the total dose of radiation to DT64-67Gy/36-38 times,for 5.6-5.8 weeks.LCAF ＋ C group of radiotherapy methods with LCAF group,while the line chemotherapy,methods with the first cycle.Results LCAF group CR ＋ PR 86.8%,LCAF ＋ C group was 94.7%.Local control rate at the first,second,third year in LCAF group were 64.7%,52.9%,35.3%;Local control rate at the first,secon,third year in LCAF＋C group were 67.6%,58.8%,Survival rate at the first,second,third year in LCAF group were 44.1%.55.9%、29.4%,23.5%;Survival rate at the first,second,third year in LCAF＋C group were 61.7%,35.3%,32.3%.The incidence of radiation esophagitis atⅠ ＋ Ⅱ grade is 50%, 58.8% in two groups. The incidence of radiation esophagitis above Ⅲ grade is11.7%, 17.6%. Difference between the two groups is significant（χ2=6.05, P=0.034）. Conclusion LCAF ＋ C group than in the LCAF group improved 3-year local control rate（35.3% VS44.1%,P 0.05） and survival （23.5% VS32.3%, P 0.05）. Decreased rate of distant metastasis （P = 0.054）.