食管癌后程加速超分割放射治疗的临床分析

Analysis of outcome and failure reasons of late course accelerated hyperfrationation radiotherapy for esophageal carcinoma

目的 分析影响食管癌后程加速超分割放射治疗疗效的因素及失败原因。方法 回顾分析本院后程加速超分割放射治疗食管癌 2 0 1例 ,放射治疗方法均为前 2 / 3病程常规放射治疗 1.8Gy/次 ,共 41.4Gy左右 ,后 1/ 3疗程缩野改为加速超分割放射治疗 (2次 /d ,1.5Gy/次 ) ,共 2 7Gy左右 ,全疗程总剂量共 6 7～ 70Gy ,40～ 43分次 ,40～ 49d完成。结果 随访时间 4～ 6 9个月 (中位 2 8个月 ) ,随访率为 92 %。 1、3、5年生存率分别为 72 .5 %、35 .6 %、31.1% ,中位生存时间为 2 4.0个月。 1、3、5年局部控制率分别为 82 .2 %、71.3%和 71.3%。在 2 0 1例病例中 ,已死亡病例 95例。其中死于局部失败 34例占死亡病例的 35 .8% ;远地转移 32例占 33.7% ;局部失败 +远地转移 4例占 4.2 % ;淋巴结转移 13例占 13 .7% ;食管出血、穿孔和放射性肺炎 12例占 12 .7%。结论 后程加速超分割放射治疗疗效较常规分割治疗的历史水平明显提高 。

Objective To define the prognostic factors and local failure in late course accelerated hyperfractionation radiotherapy(LCAHR) for esophageal carcinoma.Methods A retrospective study was conducted in 201 esophageal squamous cell carcinoma patients treated by LCAHR during the period between August 1994 to January 2000.The radiotherapeutic portals were set and based on CT scan and esophagograms. All patients received a mean dose of 41.4 Gy /23 F/4～5 WK. With conventional fractionation regimen during the first two thirds of the course,and followed by LCAHR with reduced fields, at dose of 27 Gy/18 d,1.5 Gy per fraction,twice daily. The total dose varied up to 67～70 Gy/40～43 F/40～49 d. Results The 1 ,3 and 5 year actuarial survivals were 72.5% ,35.6% and 31.1%. The 1 ,3 and 5 year local control rates were 82.2%, 71.3% and 71.3%,respectively. Of the 95 patients who died, 34(35.8%) did so from local failure , 32(33.7%) from distant metastasis(33.7 %), 13(3.7%) from lymphatic metastasis, 4(4.2%) frome both local and distant metastasis and 12(12.7%) from complications.Conclusions It is showed that significant improvement in local control and survival are observed after LCAHR for esophageal carcinoma in comparison to conventional fractionated regimen. The prevention and management of distant metastasis and lymphatic spread have become the major problems in the future.