外照射加252Cf中子腔内治疗中晚期贲门癌临床观察

Clinical observation of external irradiation combined with 252Cf brachytherapy on advanced cardiac carcinoma

目的 观察外照射结合252Cf中子腔内治疗中晚期贲门癌患者近期疗效及不良反应.方法 收集2005年3月至2010年12月间收治的48例均经病理检查证实的贲门癌患者,其中腺癌39例,鳞状细胞癌5例,印戒细胞癌4例.全部患者Karnofsky评分≥80分,无远处转移,均为首程放疗,放疗采用体外照射结合腔内治疗.体外照射：采用6 MV-X线直线加速器治疗,2 Gy/次,5次/周,总剂量38～45 Gy.腔内照射：采用ZH-1000型252Cf中子后装治疗机治疗,参考点为：距离放射源中心10 mm,照射范围：病灶上端各延长1～2 cm,3.5～4.0 Gy/次,1次/周,共3～4次,总剂量12～16 Gy.结果 进食哽噎症状明显改善,Ⅰ级18例,Ⅱ级26例,Ⅲ级4例;近期疗效评价有效率（CR＋PR） 91.7％（44/48）;生存率1年以上者39.6％,2年以上者6.3％;25例（52.1％）患者出现恶心、呕吐、食欲不佳等不良反应,骨髓抑制：Ⅰ级21例（43.8％）,Ⅱ级3例（6.3％）.结论 体外照射结合252Cf中子治疗为中晚期贲门癌患者提供了一种新的安全可靠且无痛苦的有效治疗方法.

Objective To observe the efficacy and the toxicity of external irradiation combined with 252Cf brachytherapy on advanced cardiac carcinoma.Methods 48 patients with advanced cardiac carcinoma hospitalized during March 2007 to December 2010 were recruited,in which 39 cases were adenocarcinoma,5 patients were squamous carcinoma and 4 cases were signet-ring cell carcinoma.All cases had a Kamofsky above 80,no metastasis and received radiotherapy sequenced external and internal irradiation.The external irradiation was conducted under a 6MV X linear accelerator,and a dose of 38-45 Gy （2 Gy/22 f）.The type ZH-1000 252Cf neutron breach-loading machine was used for brachytherapy with a dose of 12-16 Gy.Results Dysphagia cleared in all cases.The short-term efficacy （PR＋CR） rate was 91.7 % （44/48）.One and two year survival rate were,respectively,39.6 % and 6.3 %.25 （52.1%） patients had gastrointestinal symptoms such as nausea,vomiting and impedance,and grade 1,2 neutropenia were occurred in 21 （43.8 %） and 3 （6.3 %） patients.Conclusion External irradiation combined with 252Cf brachytherapy is a safe,effective and tolerable treatment for advanced cardiac carcinoma.