食管癌放疗后局部复发45例再程调强放疗分析

Analysis of intensity-modulated radiation therapy in 45 patients with local recurrence of esophageal cancer after radiotherapy

目的：分析食管癌放疗后局部复发患者再程调强放疗（IMRT）的可行性、近期疗效、不良反应及相关因素。方法：45例食管癌首程放疗后局部复发患者,采用IMRT行再程放疗,每次1.8-2.0 Gy,5次/周,照射剂量不等,总剂量45-60 Gy,中位剂量50.4 Gy。结果：45例患者中42例完成放疗,完全缓解8例,部分缓解27例,病情稳定7例;2级放射性食管炎18例,3级2例,2级放射性肺炎7例,3级1例,经积极治疗后症状缓解;5例于放疗后3个月内出现食管穿孔,半年内病死;3例因病情恶化而终止放疗,1例放疗后半年因肺部大出血死亡。全组1、2年总生存率分别为40.0%和17.8%,其中完全缓解者均生存2年以上。结论：食管癌放疗后局部复发患者IMRT为有效的治疗手段,有一定的临床客观缓解率,但放疗并发症亦较高,应警惕食管穿孔及3级以上放射性肺炎的发生。

Objective： To evaluate the feasibility,short-term curative effect,adverse reaction and its related factors of intensitymodulated radiation therapy（ IMRT） in patients with local recurrence of esophageal cancer after radiotherapy. Methods： Forty-five patients with local recurrence of esophageal cancer after radiotherapy were treated with 1. 8 to 2. 0 Gy of IMRT 5 times a week,a median total dose for 50. 4 Gy（ range from 45 to 60 Gy）. Results： Among 45 patients,the re-irradiation therapy in 42 patients were completed,complete response in 8 cases,partial response in 27 cases and stable disease in 7 cases were found. Grade 2 and grade 3 acute radiation esophagitis occurred in 18 cases and 2 cases,respectively. Grade 2 and grade 3 acute radiation pneumonitis occurred in 7 cases and 1case,respectively,and the patients relieved after active treatment. Five patients occurred the perforation of esophagus in 3 months after radiotherapy,and died within 6 months. Three patients terminated the radiation because of the general deterioration,1 patient died because of pneumorrhagia in six months after radiotherapy. The total survival rates of 1 and 2-year were 40. 0% and 17. 8%,respectively. The patients with complete remission survived over 2 years. Conclusions： The treatment of patients with local recurrence of esophageal cancer after radiotherapy with IMRT is effective,which has certain remission rate and high complication. The perforation of esophagus and more than grade 3 radiation pneumonitis should be alerted.