后程加速超分割三维适形放疗同步化疗治疗中晚期食管癌的临床研究

Safety and efficacy of 3D-CRT concurrent chemotherapy combined with late-course accelerated hyperfractionated radiotherapy in the treatment of advanced esophageal cancer

目的探讨后程加速超分割三维适形放疗同步化疗治疗中晚期食管癌的疗效和不良反应。方法将122例食管癌患者随机分为后程加速超分割三维适形放疗同步化疗组（观察组）60例和三维适形同步放化疗组（对照组）62例。两组前程放疗均行直线加速器三维适形照射至剂量46 Gy/23次,对照组后程放疗继续行常规分割照射至总剂量62 Gy,观察组后程改用加速超分割放疗,分次剂量1.4 Gy/次,2次/d,2次间隔时间〉6 h,至总剂量62.8 Gy。两组均于放疗同期采用紫杉醇联合顺铂2个周期方案化疗,放疗结束继续行1~2个周期巩固化疗,28 d为1个周期。结果观察组和对照组有效率分别为88.3%和64.5%,观察组1年、2年局部控制率分别为74.3%、58.7%,对照组分别为53.6%、32.6%,两组比较差异有统计学意义（P〈0.05）。观察组1年、2年生存率分别为66.7%、55.0%,对照组分别为53.2%、43.5%,差异均无统计学意义（P〉0.05）。两组急性不良反应和晚期放射反应以Ⅰ~Ⅱ级为主,两组比较差异无统计学意义（P〉0.05）。结论后程加速超分割三维适形放疗同步化疗治疗中晚期食管癌较三维适形同步放化疗可提高近期疗效及局部控制率,不良反应较轻,患者均能耐受。

Objective To evaluate the efficacy and toxicity of concurrent chemotherapy based on 3D-CRT combined with latecourse accelerated hyperfractionated radiotherapy in the treatment of advanced esophageal cancer. Methods Patients with advanced esophageal cancer（n =122） were enrolled from January 2012 to July 2014 and randomly divided into two groups ：the control group（n=62） received concurrent chemoradiotherapy based on 3D-CRT,while the intervention group（n=60） received the same chemoradiotherapy in combination with late-course accelerated hyperfractionated radiotherapy. Both groups received chemotherapy of paclitaxel and cisplatin. On the second day after chemotherapy,3D-CRT was administered to both groups using a linear accelerator;total dose of PTV was 46 Gy/23 F. The control group received conventional fractionated radiotherapy to achieve a DT of 62 Gy. The intervention group received a DT of 62.8 Gy,with doses of 1.4 Gy administered twice a day at least 6 h apart.Both groups were given another 1-2 rounds of chemotherapy after the end of radiotherapy. Results The total effective rate was significantly higher in the intervention group（88.3%） than in the control group（6 4. 5 %,P〈0. 05）. Local control rates in the intervention group were 74.3% at 1 year and 58.7% at 2 years,significantly greater than the rates of 53.6% and 32.6% in the control group（P〈0.05）. The survival rates in the intervention group were 66.7% at 1 year and 55.0% at 2 years,similar to the rates of 53.2% and 43.5% in the control group（P〉0.05）. The two groups showed similar occurrence of adverse reactions,which were primarily level 1 and 2 events. Conclusions Combining concurrent chemoradiotherapy based on 3D-CRT with late-course accelerated hyperfractionated radiotherapy may improve therapeutic efficacy and long-term survival of patients with advanced esophageal cancer. This combination therapy is not associated with higher toxicity than concurrent chemoradiotherapy on its own.