加速超分割放射治疗食管癌的毒副作用及并发症

Toxic effect and complication of accelerated hyperfractionation radiotherapy for esophageal carcinoma

目的：研究加速超分割放射治疗食管癌的毒副作用及并发症。方法：１９９０年 １２月一 １９９２年 ７月对９６例经病理证实为食管癌的患者进行了前瞻性研究。随机分成常规治疗组（ＣＦ）和加速超分割治疗组（ＣＡＦ）。常规组：每次照射 １８－２．０ Ｇｙ，总剂量为 ６０－７０ Ｇｙ／３０－３５ ｆｘ，共６－７ｗ。加速超分割组：每天２次，每次照射 １．５ Ｇｙ，总剂量为５４Ｇｙ／３．５ Ｗ，两组病人均用^(６０)Ｃｏ－γ射线外照射。结果：两组病人均顺利完成了疗程，其１、３、５年生存率ＣＦ组分别为 ４６％（２２／４８）， １９％（９／４８）， １２．５％（６／４８）；ＣＡＦ组分别为７０％（３４／４８）， ３９.６％（１９／４８）， ２９.２％（１４／４８），ＣＡＦ组病人的疗效明显优于ＣＦ组（Ｐ＜０.０５）。ＣＡＦ组病人放射性食管炎的频度大于ＣＦ组，且程度较ＣＦ组重，但两组相比无统计学意义。放射性食管炎的发生高峰时间，ＣＡＦ组在放疗的３周左右，而ＣＦ组则无明显的高峰时间，且ＣＦ组在放射治疗后症状很快消失。放射性气管炎的发生率较放射性食管炎少，时间相对较晚。ＣＡＦ组较ＣＦ组对肺及血管的影响明显，但两者无明显的统计学意义。在并发症中，早期并发症以食管穿?

Objective: To evaluate the toxic effect and complication of accelerated hyperfraction radiotherapy for esophageal carcinoma. Methods: From December 1990 to July 1992, 96 cases with esophageal carcinoma were enrolled in the study. They were divided into two groups by stractified randomization: (1)The conventional fractionation group (CF) received rountine radiotherapy 60 -70 by. (30-35 fx) ^(-1). (6-7 w)^(-1). (2) Continous accelerated fractionation radiotherapy (CAF) received 54 Gy/3. 5 w, 2fx/d, with an interval of 6 hours. The same Cobalt 60 radiotherapy were used in both groups. Results: The radiation treatments were able to be complicated without any break. The prevalence of radiation esophagitis of CAF was higher and sever than that of CF groups. But there was no sigificant difference. The peak of acute esophagitis in CAF was in about third weeks, but in CF group there was no obvious time of peak, and subsided after treatmeat. We also found fewer and less severe radiation trachetitis during treatment. The time was later than radiation esophagitis. The number of ABC in CAF was lower than that in CF, but there was no significant difference. The early complication was mainly esophageal bleeding and esophageal fistula, and the later complication was mainly esophageal stenosis, haemoptysis and continuously cough. But there was no significant difference. Conclusions: (1)CAF can be tolerated by most patients with esophageal carcinoma; (2)The toxic effect and complication of CAF is more severe than that of CF, but there was not significant difference.