中晚期食管癌后程加速超分割适形放疗同期化疗的临床观察

Clinical study on a combination regimen of late course accelerated hyperfractionated comformal radiotherapy and concurrent chemotherapy for advanced esophageal carcinoma

目的:分析中晚期食管癌后程加速超分割三维适形放射治疗同期化疗的疗效、不良反应及失败原因。方法:将食管鳞癌80例随机分为普通放化组和后程加速超分割放疗同期化疗组(后加放化组)。普通放化组常规设野照射,40Gy左右改野,总剂量DT 64-70Gy,32-35分次,全疗程35-45d。两组均于放疗前和第3-4周化疗2周期:DDP 30mg/m2,d1-d3,5-FU 500mg/m2d1-d5,CF 0.2,d1-d5。后加放化组三维适形放疗,常规分割照射DT 30-36Gy后后程加速超分割适形照射:1.5Gy/次,2次/d,共34-36Gy左右,总剂量为DT 66-70Gy,全疗程35-42d。结果:整个研究随访时间1-56个月。后加放化组的1、2、3、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%、28.4%和22.1%(P<0.05);后加放化组1、2、3、4年的局部控制率分别为72.0%、62.6%、59.1%、55.2%,稍高于普通放化组的64.6%、50.5%、47.1%、39.4%,但差异无统计学意义(P>0.05)。两组发生急性放射性气管炎、放射性食管狭窄和放射性肺纤维化的强度分布无显著性差异(P>0.05),但后加放化组的Ⅲ、Ⅳ级严重的急性食管炎明显增多(P<0.001)。普通放化组死于未控和局部复发的比例为53.3%(16/30),高于后加放化组的42.1%(8/19),但差异无统计学意义(P>0.05)。结论:后程加速超分割适形放疗食管癌同期化疗提高了1、2、3、4年生存率,但Ⅲ、Ⅳ级严重的急性食管炎明显增多,最后结论还需要更深入的研究。

Objective：To analyze the curative effect,adverse effects and cause of treatment failure of late course accelerated hyperfractionation three-dimensional conformal radiotherapy（LCAH-3DCRT） combined with concurrent chemotherapy in patients with advanced esophageal carcinoma.Methods：Eighty patients with advanced esophageal carcinoma were divided randomly into two groups：conventional radio-chemotherapy group（CRC group） and LCAH group.Patients in CRC group were treated with conventional fractionation radiotherapy to a dose of 40Gy,followed by a total dose of 64-70Gy 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 30-36Gy,which was then followed by accelerated hyperfractionation irradiation using reduced fields,twice daily at 1.5Gy per fraction,to a dose about 34 36Gy,resulting in a total dose about 66-70Gy over 35-42 days.Patients in both groups were given chemotherapy before irradiation and 3 to 4 weeks after initiation of irradiation,respectively.The regimen was as follows：DDP 30mg / m 2 at day 1 to day 3,5-FU 500mg / m 2 at day 1 to day 5,CF 0.2 at day 1 to day 5.Results：Patients were followed up for 1-56 months.The 1-,2-,3-,4-year overall survival rates were 69.5%,55.8%,43.7%,38.9% respectively for LCAH group,higher than for CRC group which 1-,2-,3-,4-year overall survival rates were 55.0%,39.7%,28.4%,22.1%,respectively（P 0.05）.The 1-,2-,3-,4-year local control rates were 72.0%,62.6%,59.1%,55.2% respectively for LCAH group,slightly higher than CRC group whose 1-,2-,3-,4-year local control rates were 64.6%,50.5%,47.1%,39.4%,respectively,but did not reach statistical significance（P 0.05）.The severity of acute radioactive bronchitis,narrow irradiation,and pulmonary fibrosis caused by irradiation were not significantly different in two groups（P 0.05）,but there were more Ⅲ-Ⅳ esophagitis patients in LCAH group than in CRC group（P 0.001）.53.3%（16 /30） of patients in CRC group died because carcinoma could not be controled and died of regional relapse,more than in LCAH group with 42.1%（8/19） patients died of the same reasons,but did not reach statistics significance（P 0.05）.Conclusion：Combination of LCAH-3DCRT and concurrent chemotherapy can improve 1-,2-,3-,4-year overall survival,but may increase the risk of Ⅲ-Ⅳ esophagitis.The results need to be further demonstrated in later studies.