IMRT/3DCRT结合锎252中子腔内治疗新疆地区中晚期食管癌临床报道

Clinical Reports of IMRT/3DCRT Combined with Cf252 Neutrons on Middle and Advanced Esophageal Cancer in Xinjiang Region

目的观察IMRT/3DCRT配合锎252(Cf252)中子腔内放射治疗中晚期食管癌的疗效及不良反应。方法收集我院2007年1月～2011年2月间收治的38例经病理检查证实食管鳞癌的患者,临床分期II、III、IV期分别为14、19、5例,全部患者KPS评分≥80分,无远处转移,均为首程放疗,放疗采用体外照射序贯腔内模式。先采用6MV X线直线加速器IMRT/3DCRT技术照射,95%等剂量线覆盖95%PTV体积,95%PTV≥50Gy,然后采用ZH-1000型Cf252中子后装治疗机治疗,总吸收剂量10～16Gy。放疗后3个月进行近期疗效评估。结果进食哽噎症状明显改善,35例症状完全消失,3例好转。急性毒副反应以放射性食管炎为主。I级放射性食管炎发生率为23.7%(9/38),II级为7.9%(3/38)。近期疗效评价有效率(CR+PR)92.1%,全组1、2年生存率分别为68%、19%。结论 IMRT/3DCRT结合Cf252中子照射是安全有效的治疗方法,具有一定的临床应用前景。

Objective To observe the effect and adverse reactions of IMRT/3DCRT combined with Cf252 neutrons on middle and advanced esophageal cancer. Methods 38 patients diagnosed with advanced esophageal squamous cancer by pathological examination during January 2007 to February 2011 in our hospital were enrolled with 14, 29 and 5 patients in clinical stages of Ⅱ,Ⅲ and IV. All cases （KPS score≥80） were in the first treatment of internal exposure combined with sequential cavity modes without distant metastasis. 6MV X-ray linear accelerator IMRT/3DCRT was initially used with 95% of PTV area covered by 95% of isotope dose （95% PTV≥50 Gy）, followed by the application of ZH-1000 Cf252 neutrons after-loader with total Gy being 10-16. Short term effect was evaluated in 3 months. Results Chokes in eating were completely disappeared in 35 and improved in 3 cases. Radiation esophagitis was the main acute toxic and adverse reactions, with the occurrencerate in Ⅰ and Ⅱ stages being 23.7% （9/38） and 7.9% （3/38） respectively. The effect of short-term evaluation （CR＋PR） was 92.1% and the survival rate in 1 and 2 years were 68% and 19%, respectively. Conclusion IMRT/3DCRT combined with Cf252 neutrons are safe and effective in the treatment of esophageal cancer, having potential prospect in clinical application.