食管癌精确放疗的研究进展

Study of esophageal cancer accurate radiotherapy

目的:总结食管癌精确放疗的国内外研究进展,为临床治疗提供依据。方法:应用PubMed和CNKI等数据检索系统及数据库,以"食管癌、放射治疗"等为关键词检索2000-01-2011-10的相关文献,纳入标准:1)四维CT、正电子发射计算机/断层显像(PET/CT)在食管癌精确放疗中的应用及靶区勾画研究进展;2)不同食管癌精确放疗计划的剂量学比较;3)食管癌精确放疗的分割方式及疗效评估。根据纳入标准分析文献36篇。结果:四维CT及PET/CT在食管癌精确定位及靶区勾画中得到很好的应用,三维适形放疗/调强化疗(3DCRT/IMRT)治疗提高了食管癌患者的局部控制率及近期生存率。Rapid Arc具有靶区剂量适形度高,剂量分布均匀性好,减少总机器跳数和减少治疗时间等优势。改变放疗方式利用3DCRT后程加速超分割比常规分割疗效略有提高,但急性放疗反应加重,晚期反应的发生率未增加。结论:食管癌精确放疗仍以3DCRT/IMRT为主,Rapid Arc技术虽然有较好的优越性,但是临床应用前景需要进一步研究。

OBJECTIVE： To summarize the recent progress in the precise radiotherapy for esophageal carcinoma, to provide instruction for clinical therapy. METHODS： The PubMed system and CNKI databases were searched using the keywords precise radiotherapy and esophageal carcinoma,published from Jan. 2000 to Oct. 2011. Criteria of paper adoption： 1） The recent progress in the clinical application and target painting for esophageal carcinoma precise radiotherapy u sing 4D-CT and PET/CT; 2） The dosimetric differences among different radiation plannings; 3） The different fractionated close schemes and clinical outcome for esophageal carcinoma precise radiotherapy. According to the above criteria, 36 papers were finally selected for analyzed and reviewed. RESULTS： The 4D-CT and PET/CT had been implemented widely in the simulation and target painting for esophageal carcinoma precise radiotherapy, 3DCRT/IMRT had improved the local control rate and recent survival rate {or the esophageal carcinoma patients. Rapid Arc had the ability to reduce monitor u- nits and treatment time,to provide adequate organs at risk（OAR） sparing and planning target volume（PTV） coverage when compared with intensity-modulated radiation therapy（IMRT）. The therapeutic effect of whole-course 3DCRT corn bined with late course accelerated hyperfractionated radiotherapy（LCAFR） for esophageal carcinomas was superior to conventional radiotherapy,and it do not increase late toxic and side effect of radiotherapy,hut increase acute toxic and side effect. CONCLUSION： 3DCRT/IMRT is still the main planning method for esophageal carcinomas, Rapid Arc is a new and advantageous planning method,and further studies are needed for this technique to apply widely.