同步整合加量调强放疗治疗颈及胸上段食管癌的临床观察

The clinical observation of the imultaneously integrated boost intensity-modulated radiotheragy in cervical and upper thoracic esophageal carcinoma

目的:观察同步整合加量调强放疗技术(SIB-IMRT)与常规调强放疗技术(IMRT)治疗颈及胸上段食管癌的不良反应及临床疗效。方法:颈及胸上段食管癌患者62例,随机分为SIB-IMRT组及常规IMRT组,同步给予单药顺铂同步化疗。处方剂量:SIB-IMRT组:PGTVnx 66Gy/(2.2Gy·30次),PGTVnd 66Gy/(2.2Gy·30次),PTV 54Gy/(1.8Gy·30次)。IMRT组:95%PTV 60Gy/(2.0Gy·30次)。结果:SIB-IMRT组1、2年的局部控制率(81.8%、64.5%)较IMRT组1、2年的局部控制率(73.5%、52.7%)提高(P<0.05)。SIB-IMRT组1、2年的生存率(77.4%、50.7%)与IMRT组1、2年生存率(74.2%、50.1%)相比,两组差别无统计学意义(P﹥0.05)。两组患者放射性气管炎和血液学毒性的发生率差异无统计学意义(P﹥0.05),SIB-IMRT组放射性肺炎、放射性食管炎的发生率较IMRT组降低(P<0.05)。结论:SIB-IMRT治疗颈段及胸上段食管癌,有可能成为提高肿瘤剂量从而提高肿瘤局部控制率、延长患者生存的首选放疗方式。

Objective To observe the toxicity and clinical efficacy of the two intensity modulated radiotherapy methods for incervical and upper thoracic esophageal carcinoma. Methods ： Sixty two patients with cervical and upper thoracic esophageal carcinoma were divided into SIB - IMRT group and IMRT group randomly. Concurrent chemother-apy with Cisplatin. Target volumes for（ PGTVnx： 66Gy,2. 2Gy X 30 fractions, PGTVnd ： 66Gy,2. 2Gy X 30 fractions,PTV ： 54Gy,l. 8Gy X 30 fractions） were predefined for patients of SIB - IMRT group. Target volume for（95% PTV ：60Gy ,2. OGy x 30 fractions） were predefined for patients of IMRT group. Results ：The median follow - up period was 18 months（range, 10 to 24 months）. And the follow - up rate was 100%. The effective rate of the two groups was 100% .1,2- year local control rate of the two groups（ LCR） were 81.8% ,64. 5% and 73. 5% ,52. 7% respectively.There was a statistically significant difference in LCR between SIB - IMRT and IMRT group. 1,2- year OS（ overall survival） were 77.4% ,50.1% and 74. 2% ,5 0 . 1% respectively. There were no significant difference between the SIB - IMRT and IMRT groups. There were no significant difference in radiation induced bronchitis acute hematologic toxicity. There was statistically significant difference in radiation pneumonitis and esophogitisand. Conclusion ： SIB - IMRT treatment for cervical and thoracic esophageal carcinoma technology was a treatment option to improve tumor lo-cal control rate and prolong the survival of patients.