食管癌外照射结合低剂量率腔内照射加热疗的疗效分析

Effects of intracavitary hyperthermia combined with external beam radiation and intraluminal brachytherapy in the treatment of esophageal carcinoma

目的 :评估低剂量率腔内照射合并热疗加外照射治疗食管癌的疗效。 方法 :低剂量率腔内照射合并热疗加外照射 (R +T +B)组综合治疗食管癌 2 5例。外照射采用 6MVX线 1.8～ 2 .0Gy 次 ,5次 周 ,5 0～ 6 0Gy 6～ 7周。休息 2周后 ,使用同一辐射器行腔内热、放疗 ,热疗 6 0min 次× 2 ,期间行低剂量率1 92 Ir腔内照射 ,参考点 (粘膜下 0 .75cm)剂量 30Gy。单纯外照射 (R)组治疗食管癌 30例 ,6MVX线照射 1.8～ 2 .0Gy 次 ,5次 周 ,6 0～ 70Gy 6～ 8周。 结果 :①R +T +B组的CR、PR、NC和PD分别为 6 0 % (15 2 5 )、2 4% (6 2 5 )、8% (2 2 5 )和 8% (2 2 5 ) ;R组为 2 7%(8 30 )、6 0 % (18 30 )、10 % (3 30 )和 3% (1 30 )。两组差异显著 (P =0 .0 41)。②R +T +B组的 1、3和 5年生存率分别为 72 % (18 2 5 )、32 % (8 2 5 )和 2 0 % (5 2 5 ) ;R组为 43% (13 30 )、16 .7% (5 30 )和 10 % (3 30 ) ,R +T +B组 1年生存率高于R组 (P =0 .0 33) ,3年和 5年生存率无明显差异 (P =0 .183;P =0 .2 95 )。③R +T +B组局部复发率 5 6 % (18 2 5 )低于R组的 83% (2 5 30 ) ,远处转移率为 32 % (8 2 5 )高于R组的 10 % (3 30 )。两组局部复发率、远处转移率比较均有显著差异 (P =0 .0 2 6 ;P =0 .0 42 )?

Objectives: To evaluate the effects of intracavitary hyperthermia combined with external beam radiation and intraluminal brachytherapy in the treatment of esophageal carcinoma. Methods: Twenty-five patients (Group R+T+B) with primary squamous cell carcinoma of the esophagus were treated with intracavitary hyperthermia combined with external beam radiation and intraluminal brachytherapy at Nanjing General Hospital of Nanjing Command. External beam radiation was given with a 6-MV X-ray; 1.8～2.0 Gy per fraction and five fractions per week; this brought the total dose to 50～60 Gy. Two weeks later, hyperthermia was applied with 915 MHz microwave intracavitary applicators, and for 1 h before and after the intraluminal radiation. Intraluminal radiation was provided by low dose rate Iridium-192 ribbons in the same intracavitary applicator, giving 30 Gy at 0.75 cm from the applicator surface. During the corresponding period, thirty patients (Group R) with primary squamous cell carcinoma of the esophagus were treated only with external beam radiation, which was given with a 6-MV X-ray, 1.8～2.0 Gy per fraction and five fractions per week; this brought the total dose to 60～70 Gy. Results:①The 3-month post-treatment responses of Group R+T+B showing complete remission, partial remission, no change and progressive disease in 60% (15/25), 24% (6/25), 8% (2/25) and 8% (2/25) of the patients respectively, and of Group R, 27%(8/30),60%(18/30),10%(3/30) and 3%(1/30) respectively. There was a significant difference between the two groups (P=0.041). ②The 1-, 3- and 5-year overall survival rates of Group R+T+B were 72%(18/25), 32%(8/25) and 20%(5/25) vs Group R 43%(13/30), 16.7%(5/30), 10%(3/30)(P=0.033; P=0.183; P=0.295). There was no significant difference in the 3- and 5-year overall survival rates between the two groups.③The local recurrence rate (either at the primary site or in the lymph nodes) or local progression of Group R+T+B was 56%(14/25) vs 83%(25/30) in Group R,P=0.026; and the rates of developed metastasis of the former was 32%(8/25) vs 10%(3/30) in the latter,P=0.042. Conclusions:External beam radiation combined with intraluminal brachytherapy plus intracavitary hyperthermia may improve the treatment results of esophageal carcinoma.