同步整合加量调强放射治疗颈及胸上段食管癌的近期疗效与安全性

Short-term Efficacy and Safety of SIB-IMRT in Cervical and Upper Thoracic Esophageal Carcinoma

目的：探讨同步整合加量调强放射治疗颈及胸上段食管癌的近期疗效与安全性。方法对30例颈及胸上段食管癌患者行调强放射治疗：采用5野或7野同步整合加量调强技术进行逆向计划设计，处方剂量：计划靶区1（PTV1）给予66 Gy（2．2 Gy＆#215;30次）的剂量照射；PTV2给予54 Gy（l．8 Gy＆#215;30次）的剂量照射。评价其近期疗效及急性放射反应情况。结果30例患者均顺利完成治疗，中位随访期为30个月（20～38个月），随访率为100％。30例患者完全缓解26例（86．7％），部分缓解4例（13．3％），有效率为100％；1、2、3年生存率分别为65．0％、42．4％和33．5％。多数病例出现放射性食道炎，放射性气管炎，均为1-2级，无须特殊处理；无骨髓抑制及急性心脏损伤。结论同步整合加量调强放射治疗颈及胸上段食管癌有较高的局控率，近期疗效满意，急性放射反应可耐受。

Objective To investigate the short-term efficacy and safety of simultaneous inte-grated boost intensity-modulated radiotherapy（SIB-IMRT）in cervical and upper thoracic esopha-geal carcinoma.Methods Five or seven-field SIB-IMRT plans were designed for 30 patients with cervical and upper thoracic esophageal carcinoma.Target volumes for primary lesions （PTV1 , 66 Gy,2.2 Gy＆#215;30 fractions）and electively treated regions（PTV2,54 Gy,1.8 Gy ＆#215; 30 fractions） were predefined for each patient.Short-term efficacy and acute radiation reactions were evaluated in all patients.Results All patients completed treatment successfully.The median follow-up peri-od was 30 months（range,20 to 38 months）and the follow-up rate was 100%.All 30 cases pa-tients,complete remission of 26 cases,partial remission of 4 cases,the effective rate was 100%. The 1-year,2-year and 3-year survival rates were 65.0%,42.4% and 33.5%,respectively.Most patients had radioactive esophagitis and bronchitis（grade 1-2）,but did not need special treatment. No bone marrow suppression and acute cardiac inj ury occurred in all patients.Conclusion SIB-IMRT can produce high local control rate,satisfactory short-term efficacy and tolerable acute ra-diation reactions in cervical and upper thoracic esophageal esophageal carcinoma.