颈部彩超联合调强放射治疗食管癌的疗效观察

THE VALUE OF CAROTID ULTRASONOGRAPHY COMBINED WITH INTENSITY MODULATED RADIATION THERAPY FOR ESOPHAGEAL CARCINOMA

目的观察颈部彩超联合调强放射治疗食管癌的治疗效果。方法选取食管癌患者86例,随机分为A组（颈部彩超组）43例和B组（对照组）43例。A组放疗前行颈部彩超检查,发现有淋巴结转移的作为累及野照射,二组均行调强放疗。操作方法：95%的PTV（计划靶区）所受剂量作为处方剂量,采用5野的调强计划,处方剂量为62-66Gy/31-33次,5次/周,随访时间36-60个月,观察局控率、颈转率、远转率、生存率。结果二组对照研究可以看出,A组在1、2、3年颈转率明显降低,P〈0.05,差异有统计学意义。在远转率和生存率方面也有所下降,但差异无统计学意义。放疗不良反应主要以1-2级为主。结论颈部彩超在食管癌的调强放疗中可作为颈部照射野的依据,能降低食管癌的颈部转移率,毒副反应可耐受。

Objective To observe the therapeutic effect in the treatment of esophageal cancer treated by IMRT combined with carotid ultrasonography.Methods A total of 86 esophageal carcinoma patients were randomly divided into group A（experimental group,43 cases）and group B（control group,43 cases）.All of patients in group A were detected by carotid ultrasonography before radiotherapy,and the areas were treated by IMRT on condition that lymph nodes metastasis was found.Both of the groups were performed by IMRT through a 5field IMRT plan.95% of tumour absorption dose in the Planning Target Volume was regarded as prescription dose which was described as 62-66Gy/31-33 times,5 times/week.Then the bureau controlling rate,lymphonodi cervicales transferring rate,distant metastasis rate and survival rate were observed in 36 to 60 months follow-up after treatment.Results Lymphonodi cervicales transferring rate in group A was significantly lower than group B in1,2,3 year（P〈0.05）.Although distant metastasis rate and survival rate in group A were lower than group B,there were no significant differences between the two groups.The side effects of radiotherapy mainly classified into grade 1 and 2.Conclusion Carotid ultrasonography can be used as a basis of neck irradiation in IMRT of esophageal carcinoma,which reduces lymphonodi cervicales transferring rate with several tolerable toxic side effects.