外照射加腔内放射治疗食管癌远期疗效分析

External irradiation combined with intracavitary brachytherapy for esophageal cancer

目的 了解常规外照射加腔内放射治疗食管癌的远期疗效、放射反应及并发症。 方法 92例食管癌患者 ,其中单纯放射治疗 (A组 ) 4 7例、外照射加腔内照射 (B组 ) 4 5例 ;外照射剂量10 0Gy/周 ,6～ 7周 ;腔内放射治疗每次 5 0～ 8 0Gy、共 1～ 3次。 结果 放射治疗结束时两组局部控制率差异无显著性意义 (P >0 0 5 ) ;局部复发率A组为 42 6 %、B组为 2 0 %,差异有显著性意义 (P<0 0 5 )。A组和B组 1、3、5年生存率分别为 5 9 6 %、2 5 6 %、10 6 %和 80 0 %、46 7%、2 6 7%;两组差异有显著性意义 (P <0 0 5 )。急性放射反应及并发症的发生与腔内放射治疗有关 ,常见为食管大出血、气管食管瘘、食管穿孔和食管狭窄。本组死亡 6 6例 ,失随访 9例 ,随访率为 90 2 %。 结论 外照射加腔内放射治疗食管癌 ,可降低局部复发率、提高远期生存率 ,但放射治疗反应与并发症发生率明显高于单纯放射治疗组。

Objective To study the long-term treatment results and acute irradiation response as well as complications following external irradiation combined with intracavitary braclytherapy. Methods After loading intracavitary brachytherapy was used for patients with esophageal cancer. In 92 patients with esophageal cancer, 47 (group A) were treated with external irradiation only, and 45 (group B) with external irradiation and brachytherapy. The doses were 60.0 Gy-70.0 Gy per 6-7 week for external irradiation, using 8 or 10 MV liner accelerator, and 5.0-8.0 Gy per fraction for intracavitary therapy. Results There was a significant difference in acute response and complications as well as local recurrence rate between the two groups (P<0.05). The survival rates of groups A and B at 1,3 and 5 years were 59.6%,25.6%,10.6% and 80.0%,46.7%,26.7% respectively (P<0.05 respectively, using χ 2 test). The complications related to intracavitary irradiation were esophageal perforation, esophagorrhagia, esophagotracheal fistula and esophageal narrowing. 66 patients died and 9 lost follow-up, giving a follow up rate of 90.2%. Conclusion External irradiation combined with afterloading intracavitary brachytherapy for esophageal cancer can reduce the local recurrence and enhance the long-term survival but with an increase of complications compared with the patients treated with external irradiation alone.