加速加常规分割治疗食管癌锁骨上淋巴结转移43例

Radiotherapy of SCLNM from EPC by Combining Accelerated & Conventional Fractionation 43 cuses

目的 探讨加速结合常规分割放疗对食管癌锁骨上淋巴结转移的治疗作用。方法 随机造反９９４年１０月至１９９７年６月间的４３例食管癌锁骨上淋巴结转移的病人，先给予加速分割放疗，２０ＧＹ／４Ｆｓ／５ｄａｙｓ，然后是常规分割放疗；２８－３５ＧＹ／１５－１８Ｆｓ／３－４Ｗｅｅｋｓ，放射源采用＾６０钴、与此同时，结合上消化道鳞癌常规分割放疗失败的主要原因是肿瘤干细胞的加速再增上生物学特性，对本疗法

Purpose:To investigate the response of supraclavicular lymph nodes metastases(SCLNM)arising from esophageal carcinoma(EPC)by irradiation that combined accelerated & conventional fractionation.Materals &Methods:43 patients with SCLNM had received the radiotherapy that combined accelerated & conventional fractionation from October,1994 to June,1997.In the first place,AD(air dose)20Gy/4Fs/5days had been delivered;next,TD(tumour dose).28 35 Gy/15 18Fs/3 4weeks had been given.The radiation source was cobalt 60.Meanwhile,according to the main cause of failure of conventional fractionation for squamous cell carcinoma from superior digestive tract was the accelerated reproliferation of malignant stem cell,the procedure had been analysed with L Q model.Results:In this series,all cases had received follow up for one year,the total response rate(CR 31/43+PR 10/43)was 95 3%;Cutaneous fibrosis had been observed in protals of 4 cases,incidence of damage was 9 30% to 1 ate responding tissue.It would be the kdy dose of well responded to conventional fraction dose of 35Gy.Conclusion:The advantage of this procedure is to have shortened the course significantly,therefore.It would prevent malignancy from accelerated stem cell reproliferation & promote responding ratio of malignancy.There are high completed responses & low side effects to this means,it would be attibuted to that accelerated fractionation could kill the proliferative stem cell in metastases with poorer differentiation & higher mitotic index and evade simultaneously severe complication of late responding tissue by engaging accelerated fraction in whole course.It is beneficial in improving the survival quality & prolonging the survival period of patients the expense is relieved & the usage rate of ward bed is increased to patients.