不均等剂量放射治疗食管癌远期疗效

Results of unequal fractionation radiotherapy for esophageal carcinoma

目的 探讨不均等剂量放射治疗食管癌的可行性。方法 16 0例食管鳞癌患者 ,信封法随机分为不均等剂量组 80例 ,常规剂量组 80例。入组者需无明显食管龛影及穿孔征象。两组均采用模拟机定位 ,体外 3个野照射。不均等剂量组 4Gy/次 ,5d/周 ,第 2周开始 2Gy/次 ,5d/周 ,共 70Gy 6周。常规剂量组 2Gy/次 ,5d/周 ,共 70Gy 7周。结果 全部病例随访 5年以上。局部控制率不均等剂量组和常规剂量组分别为 46 .3 %、2 7.5 % (χ2 =6 .15 0 ,P =0 .0 2 2 )。 1、3、5年生存率不均等剂量组分别为 72 .5 %、38.8%、31.3% ,常规剂量组分别为 5 7.5 %、2 3 .8%、16 .3% (χ2 =4.187,P =0 .0 43 ;χ2=5 .141,P =0 .0 37;χ2 =5 .45 2 ,P =0 .0 32 )。晚期放射损伤 (肺纤维化、食管狭窄、食管溃疡 )发生率低 ,两组无明显差异。结论 前程加大放射治疗剂量 ,短时间内大量杀灭肿瘤敏感细胞 ,提高了局部控制率和远期生存率 ,并且不增加副反应。不均等剂量放射治疗食管癌优于常规剂量 。

Objective To seek an effective and feasible treatment for esophageal carcinoma with unequal fractionation radiotherapy.Methods 160 patients with esophageal squamous carcinoma were randomized into an unequal frationation radiotherpy (UEFRT) group and a conventional fractionation radiotherapy (CFRT) group with 80 cases on each side. All the patients were simulated and irradiated by three port technique. Patients in the UEFRT group received D T70 Gy, at 4 Gy once daily, 5 days in the first week, then at 2 Gy daily, 5 days per week during the following five weeks. In the CFRT group,70 Gy was delivered with the routine regimen. Results The 5 year local control rates in UEFRT and CFRT groups were 46.3% and 27.5%(P<0.05), respectively. The 1 ,3 ,5 year survival rates were 72.5%,38.8% and 31.3% in UEFRT group and 57.5%,23,8% and 16.3% in CFRT group (P<0.05). Differences were present though without any significance in the late complications between these two groups.Conclusions The local control and long term survival outcome of unequal fractionation radiotherapy are better than the conventional fractionation radiotherapy. It is speculated that intensive irradiation in a short time may sensitize more the tumor cells which are more readily exterminated with the entire biological effect of radiotherapy being enhanced. It is shown that unequal fractionation radiotherapy is an effective and feasible approach in the management of esophageal carcinoma.