高剂量率腔内放疗配合外照射治疗食管癌的临床研究

Clinical Study on HDR Brachytherapy and External Radiotherapy for Esophageal Cancer

目的：探讨高剂量率腔内近距离放疗配合外放射治疗食管癌的价值。方法：1990年3月至1993年6月随机分组对照研究了185例食管癌。对照组80例，内外结合组（治疗组）105例。对照组用直线加速器常规外照射60～70Gy。治疗组在外照射58～60Gy后1～2周加内照射2～3次，每次5～8Gy，间隔5～7天。腔内照射剂量范围为外照射前病灶上下端延长1cm。结果：1）对照组和治疗组1、3、5年生存率分别为40．2％、26．25％、12．50％和62．25％、32．38％、19．05％。两组间1年生存率有显著的差异P＜0．05，3、5年生存率差异不显著。2）治疗组中病灶＜7cm和≥7cm两者的1、3、5年生存率中仅1年生存率有显著差异，3、5年生存率无显著差异。3）把治疗组按初诊时有无胸、背痛分类，发现1年生存率有显著差异，3、5年生存率差异不显著。4）从治疗组治疗后复查食管钡餐发现，病灶＜7cm患者中钡餐改变明显与不明显的1年生存率有显著差异P＜0．05，3、5年生存率差异不明显。病灶≥7cm患者中钡餐改变明显与否的1、3、5年生存率均无明显差异。结论：高剂量率腔内近距离放疗配合外照射治疗食管癌可改善进食，提高1年生存率。对3、5年生存率的影响尚待进一步观察。治疗后食管炎发生率明显增加71．4％。

Objective To evaluate the clinical application of external radiotherapy combined with high－dose－rate HDR intraluminal brachytherapy for esophageal cancer． Methods From March 1990 to June 1993 185 cases of esophageal cancer were randomly allocated into two groups． One hundred and five cases treatment group received 58～60Gy of external radiation plus 15～16Gy of brachytherapy in two or three fractions at a point 1cm from the source． Eighty cases control group received 68～70Gy of external radiation only． The field length of HDR intraluminal brachytherapy was 1cm above and below the superior and inferior margins of the tumor． Results 1 The 1－ 3－5－year survival rates in the patients of control group were 40．2％ 26．25％ 12．5％ respectively and those of the treatment group were 62．25％ 32．38％ 19．05％ respectively． Significant difference was observed between the two groups in one year survival rate but no significant difference was observed in 3－ and 5－year survival rates． 2 In the treatment groupsignificant difference was only observed in the tumor less than 7cm in 1－year survival rate but no significant difference was observed in 1－ 3－ 5－year survival rates when the size of the tumor exceeded 7cm． 3 Significant difference was observed in 1－year survival rate in the treatment group patient with breast or back pain． 4 In the treated patient with tumor less than 7cm having prominent or non－prominent braium meal changes significant difference in 1－year survival rate was observed P＜0．05 but the difference was not significant in 3－5－year survival rates．when the tumor size was greater than or equal to 7cm． Conclusion As our experience HDRIBT boost after ERT is proven to be safe and effective for patients with esophageal cancer． The one year survival rate of whom treated with HDRIBT and ERT is better than ERT alone． No siginificant difference is observed in 3 or 5 year survival rate． Esophagitis is commonly seen when treated with HDRIBT and ERT． The post－therapeutic esophageal trauma is one of the reasons affecting the long－term survival rate．