食管癌三维适形、调强放疗与常规放疗的临床效果比较

Comparison of the clinical effects of three-dimensional conformal radiotherapy,indensity modulated radiotherapy,and conventional radiotherapy in the treatment of esophageal cancer

目的:比较常规放疗(CR)、三维适形放疗(3D-CRT)及调强放疗(IMRT)治疗食管癌的照射体积、近期、远期疗效。方法:回顾性分析127例食管癌患者的临床资料,其中CR组42例,3D-CRT组45例,IMRT组40例,分析近期、远期疗效及不良反应发生情况,比较3组肿瘤体积(GTV)、临床靶体积(CTV)、计划靶体积(PTV)和临近危及器官(OAR,双肺、脊髓、心脏)的照射体积。结果:靶区比较发现,GTV、CTV及PTV平均值在CR组、3D-CRT组和IMRT组逐渐增加,且均具有统计学差异(P<0.05);同时GTV、CTV及PTV最小值在CR组、3D-CRT组和IMRT组逐渐降低,且均具有统计学差异(P<0.05)。OAR比较发现,GTV、CTV及PTV的最大值在CR组、3D-CRT组和IMRT组逐渐减小,3D-CRT组显著低于CR组,IMRT组显著低于3D-CRT组(P<0.05)。3D-CRT组和IMRT组临床疗效显著高于CR组(P<0.01),但3D-CRT组和IMRT组临床疗效差异无统计学意义(P>0.05)。3D-CRT组和IMRT组不良反应发生率显著低于CR组(P<0.01),但3D-CRT组和IMRT组不良反应发生率无明显差异(P>0.05)。3组1年生存率差异差异无统计学意义(P=0.144),但3D-CRT组和IMRT组的3年和5年生存率显著高于CR组(P<0.05)。结论:3D-CRT和IMRT能显著提高食管癌的近期及远期疗效,并减轻患者的放射性损伤,适合临床应用推广。

Objective：To compare the irradiation volume,short-term and long-term efficacy of conventional radiotherapy（CR）,three-dimensional conformal radiotherapy（3D-CRT）,and indensity modulated radiotherapy（IMRT）in the treatment of esophageal cancer.Methods：A retrospective analysis method was adopted.The patients were divided into CR group（n=42）,3D-CRT group（n=45）,and IMRT group（n=40）.A follow-up visit was paid to collect the short-term and long-term efficacy,and the occurrence of adverse reactions.The gross tumor voluem（GTV）,clinical target volume（CTV）,planning target volume（PTV）,and irradiation volume of organs（bilateral lungs,spinal cord,and heart）at risk（OAR）in the three groups were compared.Results：It was found by target volume comparison that the mean values of GTV,CTV,and PTV in the three groups were significantly increased（P〈0.05）;meanwhile,the minimum values of GTV,CTV,and PTV in the three groups were significantly reduced（P〈0.05）.It was found by OAR comparison that the maximum values of GTV,CTV,and PTV in the three groups were gradually decreased,those in 3D-CRT group were significantly lower than those in CR group,and those in IMRT group were significantly lower than those in 3D-CRT group（P〈0.05）.The clinical efficacy in 3DCRT group and IMRT group was significantly higher than that in CR group（P〈0.01）,but the comparison between 3D-CRT group and IMRT group was not statistically significant（P〉0.05）.The occurrence rate of adverse reactions in 3D-CRT group and IMRT group was significantly lower than that in CR group（P〈0.01）,but the comparison between 3D-CRT group and IMRT group was not statistically significant（P〉0.05）.The comparison of 1-year survival rate among the three groups was not statistically significant（P=0.144）,but 3-year and 5-year survival rates in 3D-CRT group and IMRT group were significantly higher than those in CR group（P〈0.05）.Conclusions：3D-CRT and IMRT can significantly enhance the short-term and long-term efficacy for esophageal cancer patients,and alleviate the radioactive damage;therefore,they are deserved to be widely recommended in the clinic.