^(252)Cf中子近距离放疗加外照射治疗食管鳞癌708例临床分析

Treatment outcomes for 708 esophageal squamous cell cancer patients that were treated with neutron brachytherapy in combination with external beam radiotherapy

目的外照射配合内照射是局部晚期食管癌的重要治疗方式之一,本研究评价锎(^(252)Cf)中子腔内近距离放疗配合外照射治疗708例食管癌的长期疗效及毒副作用。方法长治市肿瘤医院2001-01-01-2012-03-01共收治食管鳞癌708例,均采用^(252)Cf中子近距离腔内放疗配合外照射治疗。根据美国癌症联合委员会第6版食管癌分期标准,Ⅰ、ⅡA、ⅡB、Ⅲ和ⅣA期分别为7、254、31、404和12例。近距离治疗2~5次,3.5~5.0Gy/次,总剂量为8~25Gy;外照射剂量为50~56Gy,常规分割,5~6周完成。结果全组中位生存时间和1、3、5年生存率分别为23.6个月、71.6%、41.8%和32.1%。在预后和局部控制率多因素分析中,照射总剂量是唯一与长期生存和局部控制均相关的因素。<60、60~68和>68Gy的5年生存率分别为27.5%、35.3%和22.1%,P<0.001。在治疗期间未发生与治疗相关的食管穿孔和大出血。97例(13.7%)发生3度白细胞降低。635例(89.7%)在治疗过程有1~2级的食管炎反应。随访期间18例(2.5%)发生食管穿孔,35例(4.9%)发生大出血。从治疗开始到随访健在,或者发现复发或远处转移,490例(69.2%)患者吞咽普食顺利,放疗后13例(1.8%)发生食管狭窄,需要间断食管扩张治疗。结论 ^(252)Cf中子腔内近距离放疗配合外照射治疗,提高了食管癌放疗的局部控制率和长期生存率,毒副作用在可以接受范围内,是一种较好的治疗方案。

OBJECTIVE External beam radiotherapy combined with brachytherapy was an important treatment re- gime for local advanced esophageal cancer. The aim of this study was to retrospectively observe and analyze the long-term treatment outcomes and side effect for a total of 708 esophageal squamous cell cancer patients who were treated with Cali- fornium-252 （252Cf） neutron brachytherapy （NBT） in combination with external beam radiotherapy （EBRT）. METHODS From November 2001 to March 2012,708 patients of esophageal cancer underwent NBT in combination with EBRT. The patient numbers distributed over various cancer stages I , II A,IIB, III and IVA were 7,254,31,404 and 12, respectively. The total radiation dose to the reference point via NBT was 8-25 Gy in 2-5 fractions with one fraction per week. The total dose via EBRT was 50-56 Gy delivered over a period of 5- 6 weeks with normal fractionation. RESULTS The overall median survival time was 23.6 months. The 1-, 3- and 5-year survival rates were 71.6 %, 41.8 %, and 32.1% ,respectively. It showed that radiation dose is the only factor that was likely to be associated with the overall survival and local control rates. The 5-year survival rates for radiation dose 〈60 Gy,60-68 Gy and 〉68 Gy, were 27.5% ,35.3% and 22.1% ,respectively （P〈0. 001）. For acute toxicity,no esophageal perforation was found during the treatment period. Totally 97 cases （or 13. 7%） developed the Grade Ill toxicity in the blood. A majority of the patients （635,or 89.7%） developed grades 1 and 2 esophagitis during treatment. Among all the patients,18 cases （or 2.5%） and35 cases （4.9%） were found esophageal perforation and massive bleeding during the follow-up period. Esophagus stric- tures occurred in 13 patients （or 1.8%） and temporary expansion of the esophagus was needed during treatment. CON- CLUSIONS The clinical data showed that NBT in combination with EBRT produced favorable local control and long-term survival rates for patients with esophageal cancer and the side effects are tolerable. We conclude that this dual-modality method is an effective and safe way for treating esophageal cancer.