改良同步后程加速超分割放化疗治疗局部晚期食管鳞癌的临床观察

Clinical observation of improved late course accelerated hyperfractionated radiotherapy with concurrent chemotherapy for locally advanced esophageal squamous cell carcinoma

目的探讨改良同步后程加速超分割放疗联合含铂类方案的化疗治疗局部晚期食管鳞癌的疗效和不良反应。方法68例经病理证实的食管鳞癌患者入组。先行常规分割放疗40Gy／20次后改行加速超分割放疗1．4Gy／次，2次／d，间隔I〉6h，照射14次，总剂量59．6Gy。同步给予以顺铂为基础的联合化疗2个周期，同步放化疗结束后再行2周期化疗。观察患者近期疗效，1、3、5年生存率及治疗相关不良反应。结果所有患者完成放疗计划，总有效率为91．6％（62／68）。1、3、5年生存率分别为75．5％、46．5％、22．7％。I〉3级放射性食管炎的发生率为26．4％；无3级及以上的放射性肺炎发生；放射性皮肤损伤多为0—1级；3级白细胞减少和血小板减少的发生率分别为29．4％和7．4％，4级白细胞减少和血小板减少的发生率均为2．9％。无食管狭窄及严重的肺纤维化发生，有2例（2．9％）出现食管纵隔瘘。结论改良同步后程加速超分割放化疗治疗局部晚期食管鳞癌疗效满意，治疗相关不良反应发生率降低。

Objective To assess the efficacy and the adverse effects of improved late course acceler- ated hyperfractionated radiotherapy （LCAHRT） combined with cisplatin-based chemotherapy for locally advanced esophageal squamous cell carcinoma （ESCC）. Methods 68 Patients with pathologically confirmed ESCC were enrolled. Conventional fractionation was implemented to 40 Gy/20 fractions, followed by LCAHRT delivered 2 fractions of 1.4 Gy with an interval of 6-8 hours per day to 14 fractions, thus the total dose was 59.6 Gy. Two cycles of cisplatin-based chemotherapy were administered concurrently, followed by two more cycles. The short-term efficacy of treatment, overall survival for 1-, 3-,. 5-year, and treatment-related toxicity were evaluated. Results All patients successfully completed LCAHRT and the overall response rate was 91.6% （62/68）. The overall survival rate of 1-, 3-, and 5-year was 75.5% , 46.5% , 22.7% , respectively. The incidence of radiation esophagitis （ grade 3 or greater） was 26.4% , and no patients developed grade 3 or worse radiation pneumonitis. The radiation-induced skin injury were most of grade 0 or 1. Grade 3 of leucopenia and neutropenia were observed in 29.4% and 7.4% of patients, respectively, and grade 4 were both in 2.9%. During long-term follow-up, no esophageal stenosis and severe pulmonary fibrosis was developed except for two cases（2.9% ） of esophageal mediastinal fistula. Conclusion Late course accelerated hyperfractionated radio- therapy combined with chemotherapy yields promising long-term survival, with lower treatment-related toxicity for patients of locally advanced esophageal squamous cell carcinoma.