^252 Cf腔内照射治疗食管癌疗效与病变外侵程度的相关性

Relationship between ^252cf neutron ray intracavitary irradiation and esophageal carcinomaextensive infiltration on CT

目的观察^252 Cf中子射线内照射治疗食管癌的疗效与食管肿瘤外侵程度及病变长度的关系及对患者预后的影响。方法对32例食管癌患者进行外照射加^ 252 Cf腔内照射治疗，常规外照射38Gy／19次（2Gy／次，1次／13，5次／周）后，开始内外照射同期进行，内照射4Gy／次，1次／周，共12Gy／3次，外照射总量为50Gy。结果病变长度≤5cm患者1、3、5年局部控制率及生存率明显高于〉5cm患者，分别为93．75％、76．70％、65．75％和93．75％、56．25％、43．75％（x^2=7．01，P〈0．05）；60．94％、27．08％、27．08％和75．00％、18．75％、12．50％（x^2=5．96，P〈0．05）。最大浸润深度≤1．5cm患者1、3、5年局部控制率及生存率明显高于最大浸润深度〉1．5em患者，分别为92．31％、73．85％、61．54％和92．31％、61．54％、46．15％（x^2=3．87，P〈0．05）；67．67％、35．45％、35．45％和73．68％、21．05％、15．79％（x^2=6．24，P〈0．05）。病变长度≤5cm且浸润深度≤2．0cm患者与病变长度〉5cm且浸润深度〉2．0em患者比较，局部控制率和生存率差异有统计学意义（x^2=10．09、7．97，P〈0．05）。结论食管癌病变长度≤5em，CT最大外侵≤1．5cm，可能是^252 Cf中子射线腔内照射的最好适应证。而当病变长度≤5cm且肿瘤最大浸润深度≤2cm时也可作为^ 252 Cf中子射线腔内照射的较佳选择。

Objective To explore the relationship between esophageal carcinoma extensive infiltration and lesion length and 252 Cf intraeavitary braehytherapy, and to evaluate its prognostic influence. Methods Thirty-two patients with esophageal carcinoma were treated by external beam and 252Cf intracavitary radiation. The patients were first treated with conventional fraetionated radiation to a dose of 38 Gy over 4 weeks, with 5 daily fractions of 2 Gy per week, and then treated with external and intracavitary radiation concomitantly （4. 0 Gy per fraction, once a week on every Saturday to 12 Gy in 3 fractions）. The total dose of external irradiation was 50 Gy. Results The local control rate （LCR） at 1, 3 and 5 years was 93.75% , 76. 70% and 65.75% in the patients with ≤5 cm lesion （NMT5 group） , and 60. 94%, 27.08% and 27.08% in the patients with ≤5 cm lesion （MT5 group）, respectively （X2 = 7.01 ,P 〈0. 05）. The 1-, 3-and 5-year survival rate （SR） was 93.75% , 56.25% and 43.75% in the NMT5 group, and 75.00% , 18.75% , 12. 50% in the MT5 group, respectively （X^2 = 5.96 ,P 〈 0.05 ）. The LCR at 1, 3 and 5 years was 92.31%, 73.85% and 61.54% in the patients with ≤1.5 cm infiltration depth （NMT1.5 group）, and 67.67% , 35.45% and 35.45% in the patients with 〉 1.5 cm infiltration depth （ MT1.5 group）, respectively （X^2 = 3.87, P 〈 0.05 ）. The 1-, 3-and 5-year SR was 92.31%, 61.54% and 46. 15% in the NMT1.5 group, and 73.68%, 21.05% and 15.79% in the MT1.5 group, respectively （X2 = 6.24,P〈 0.05）. LCR and SR in the patients with ≤5 cm lesion and ≤2 cm infiltration depth were significantly better than those with 〉 5 cm lesion and 〉 2 cm infiltration depth （X^2 = 10. 09,7.97, P 〈 0. 05 ）. Conclusions The patients with ≤5 cm lesion length or those with≤ 1.5 cm infiltration depth, might become the most adaptable indication for ^252 Cf intracavitary radiation. In addition, those patients with ≤2 cm infiltration depth and ≤5 cm lesion length were also suitable for ^242Cf intraceavitarv racllatinn.