常规、后超外照射及外照加腔内照射治疗中晚期食管癌的疗效分析

The Effects of Conventional Fractionation,Accelerated Hyperfractionation,External and Intracavitary Irradiation in Treatment of Advanced Esophageal Carcinoma

目的:观察和比较常规分割、后程加速超分割外照射及外照射加腔内照射三种方法治疗中晚期食管癌的疗效及其放射反应。方法:从1994年5月至1995年6月对111例中晚期食管癌患者进行了常规分割外照射、后程加速超分割放疗及常规外照射加腔内近距离照射的随机分组研究。所有病例均为鳞癌,无锁骨上淋巴结转移及远处转移,年龄在40～75岁。常规分割照射组(常规组)40例:6000cGy/30次·6周,每日1次,1次200cGy,每周5天。后程加速超分割组(后超组)41例:前3周常规分割,3000cGy/15次·3周,后2周加速超分割照射,3000cGy/20次·2周,每日2次,每次150cGy,每周5天。外照射加腔内照射组(外加内组)30例;常规外照射至3500cGy时行腔内照射,外照射不停(仅内照射当天停1次),内照射500cGy/次,1次/周,内照2次共1000cGy,外照射总量为5000cGy。所有病例随访达3年。结果:常规组、后超组及外加内组的1～3年生存率分别为57.5%、56.1%、53.3%和22.5%、29.3%、26.7%,各组生存率相比无统计学差异。3组食管炎发生率分别为22.5%、41.5%和50.0%,后超组及外加内组的食管炎发生率较高。结论:后程加速放疗及外照射加内照射治疗中晚期食管癌均未能明显提高生存率,且食管炎发生率较高,具体哪一种照射方法为最佳治疗方案,下结论仍为时过早。

Objective:To compare the effects of local advanced esophageal carcinoma treated by conventional fractionation,late course accelerated hyperfractionation,external and intra-cavitary irradiation.Methods:From May1994to June1995,one hundred and eleven patients with local advanced esophageal carcinoma were randomly divided into three groups:conventional fractionation group(CF),late course accelerated hyperfrationation group(LCAH)and combined ex-ternal and in tracavitary irradiation group(CEII).All patients were squamous cell carcinoma with-out supraclavicular lymph node metastasis and distant metastasis.The patients aged40to72years and con sisted of male67cases and female44cases.Forty patients were treated by con-ventional fractionation irradiation at the dose of6000cGy /30times /6weeks(200cGy qd for5times /week).In LCAH group,41patients were treated with conventional fractionation irradiation3000cGy /15times /the first3weeks,and treated with accelerated hyperfractionation irradiation3000cGy /20times /for the later two weeks(150cGy bid for5days /week).In the CEII group, 30patients were treated initially with external conven tional fractionation irradiation up to the dose of3500cGy,then an intracavitary irradiation of500cGy /one time /week for two weeks with a to-tal dose of1000cGy was given.The external irradiation was omitted once on the time of internal irradiation and the total dose of external irradiation was5000cGy.All the patients were followed up for three years.Results:1)The instant response rates of the CF group,LCAH group and CEⅡgroup were95%(38/40),100%(41/41)and100%(30/30)respectively.2)The1-,3-year sur-vival rates of the three groups were57.5%,56.1%,53.3%and22.5%,29.3%,26.7%respec tive-ly.There was no statistical difference of survival rates among the three groups.The irradi ation esophagitis was higher in the LCAH and CEII groups.Conclusion:The results show that the late course accelerated hyperfractionation and intracavitary irradiation does not improve the1-,3-year survival.The irradiation esophagitis rate is higher in the LCAH group and CEII group.The long-term survival needs to be studied further.