不同分割放疗技术治疗食管癌近远期疗效对比研究

Comparative study of near-term and long-term curative effects of different fractionated radiotherapies on esophageal cancer

目的探讨不同分割放疗技术治疗食管癌近远期疗效。方法选取我院收拾的160例食管癌患者,随机分为常规分割(CF)、普通后程加速超分割(LCAHF)、三维适形常规分割(3D-CF)和三维适形后程加速超分割(3D-LCAHF)4个治疗组,观察比较治疗后各组的缓解率、生存率、中位生存期、放射副作用及转移复发率等指标。结果患者在接受完相应的疗程后,4组总缓解率没有统计学差异(P>0.05)。但是在完全缓解率(CR)上,LCAHF组显著优于CF组(P<0.05);3D-LCAHF组显著优于3D-CF组(P<0.05);而CF与3D-CF组之间以及LCAHF与3D-LCAHF组之间没有统计学差异(P>0.05)。远期疗效结果表明,1年生存率4组之间没有统计学差异(P>0.05);LCAHF、3D-CF和3D-LCAHF组3年生存率显著优于CF组(P<0.05)。采用后程加速治疗方案的治疗组的中位生存期显著长于常规治疗组(P<0.05);采用三维适形放疗组的急性放射性肺炎和急性放射性食道炎的发病率显著低于常规放疗组(P<0.05);采用后程加速超分割治疗方案的治疗组的转移复发率显著低于采取常规治疗方案组(P<0.05)。结论三维适形技术后程加速超分割治疗食管癌,在近远期疗效以及放射治疗相关副作用上均具有一定的优势,在临床上可以借鉴使用。

Objective To explore the near-term and long-term curative effects of different fractionated radiotherapies on esophageal cancer. Methods A total of 160 patients of esophageal cancer admitted in our hospital were selected and randomly divided into four therapeutic groups： conventional fractionation（CF） group, ordinary late-course accelerated hyperfractionation （LCAHF） group, 3D conformal conventional fractionation（3D-CF） group, and 3C conformal late-course accelerated hyperfractionation（3D-LCAHF） group. The remission rate, survival rate, median survival time, adverse effect of radiotherapy and metastatic rate of the groups were observed and compared after treatments. Results After receiving corresponding treatments, the patients in the four groups showed no significant difference in total remission rate （P 〉 0.05）. However, as for the complete remission rate （CR）, the result in the LCAHF group was significantly superior to that in the CF group （P 〈 0.05）, and the result in the 3D-LCAHF group was obviously superior to that in the 3D-CF group （P 〈 0.05）. Regarding groups CF and 3D-CF, and groups LCAHF and 3D-LCAHF, no significant differences were found between them（P 〉 0.05）. As shown in the results of long-term curative effects, there was no significant difference occurring among the four groups in 1-year survival rate （P 〉 0.05）, whereas groups LCAHF, 3D-CF and 3D-LCAHF had significantly higher 3-year survival rates than the CF group （P 〈 0.05）. The median survival time in the therapeutic groups subject to the late-course accelerated treatments was significantly longer than the conventional treatment groups （P 〈 0.05）. Groups subject to 3D conformal radiotherapies showed significantly lower rates of incidence of acute radiation pneumonitis and acute radiation esophagitis than groups receiving conventional radiotherapies （P 〈 0.05）, while groups subject to late-course accelerated hyperfractionation therapies showed significantly lower metastatic rates in comparison with groups receiving conventional treatments （P 〈 0.05）. Conclusion The 3D conformal and late-course accelerated hyperfractionation radiotherapy shows certain advantages in both near term and long term curative effects and adverse effects of radiotherapies, which can be considered and applied clinicaUy.