^(252)锎联合外照射治疗食管癌的放射性损伤与剂量的相关性研究

Correlation between dose and radioactive damage in the treatment of esophageal cancer by californium-252 combined with external radiotherapy

目的探讨252锎(Cf)联合外照射治疗食管癌的放射性损伤与剂量的相关性。方法选取我院放疗科经252锎腔内后装放疗联合外照射治疗食管癌患者30例,记录252Cf和外照射剂量,分析不同照射剂量对急慢性放射性损伤的影响。结果外照射平均照射剂量为(50.02±7.31)Gy,252Cf平均照射剂量(12.44±3.01)Gy,治疗4周内出现放射性食管炎14例,急性放射性损伤发生率为46.67%(14/30),其中外射线照射高剂量组患者急性放射性损伤发生率(73.33%)明显高于低剂量组(20.00%),两组比较差异具有统计学意义(P<0.05),治疗后2~5个月,出现食管溃疡2例,治疗后3~15个月出现食管狭窄3例,治疗后14个月出现食管瘘1例,慢性放射性损伤发生率为20%(6/30),其中252Cf快中子射线照射高剂量患者慢性放射性损伤发生率明显高于低剂量患者(P<0.05)。结论放射性食管炎与外照射剂量相关,而慢性放射性损伤与252Cf照射剂量相关。

Objective To investigate relationship between dose and radioactive damage using californi-um-252 （252Cf） combined with external radiotherapy for treating esophageal cancer. Methods Thirty patients of esophageal cancer treated with 252Cf intracavitary brachytherapy combined with external radiotherapy were selected. The doses of 252Cf and external radiotherapy were recorded, and the acute and chronic radioactive damages by different irra-diation doses were analyzed. Results The average dose of external radiotherapy was （50.02 ± 7.31） Gy, and the average dose of 252Cf was （12.44±3.01） Gy. After four weeks of treatment, 14 patients were found with esophagitis. The incidence of acute radioactive damage was 46.67 （14/30）, and the incidence was significantly higher in high dose X ray irradiation group than low dose group （73.33%vs 20.00%, P〈0.05）. 2-5 months after treatment, 2 patients were found with esopha-geal ulcer, and 3 patient developed esophageal stenosis 3-15 months after treatment. 14 months after treatment, 1 patient was found with esophageal fistula. The incidence of chronic radioactive damage was 20%（6/30）, and the incidence in was significantly higher in high dose 252Cf fast neutron irradiation group than low dose group （P〈0.05）. Conclusion Radioac-tive esophagitis is related to irradiation dose, and chronic radioactive damage is related to 252Cf radiation dose.