食管癌根治性放化疗近期疗效和不良反应剂量学分析

Dosimetric analysis on the short-term curative effect and adverse reaction of radical chemoradiotherapy for esophageal carcinoma

目的:探讨食管癌根治性放化疗的临床效果和急性不良反应的剂量学评价。方法:选取180例接受放化疗的食管癌患者,依据肿瘤照射剂量、肿瘤长度、双肺受量、脊髓最大受量等不同临床特征进行分组,对比分析肿瘤长度和剂量、肺V20及脊髓Dmax对近期疗效和急性不良反应的影响;放射治疗方式对患者治疗费用和治疗日的影响。结果:高剂量组与低剂量组近期疗效和远期生存率比较,差异无统计学意义;放射性肺炎与双肺受量、肿瘤剂量及肿瘤长度相关,骨髓抑制与最大点剂量、肿瘤剂量及肿瘤长度相关。结论:在所采用的剂量范围内,高剂量并不能带来食管癌放射治疗患者高获益,肿瘤高剂量将带来更严重的副反应,放射治疗急性副反应主要受肿瘤剂量和肿瘤长度影响。

Objective:ABSTRACTTo explore dosimetric evaluation on the clinical effect and acute adverse reaction of radical chemoradiotherapy for esophageal carcinoma.Methods:A total of 180 patients with esophageal carcinoma who underwent chemoradiotherapy were selected.And they were divided different groups according to exposure dose of tumor,the length of tumor,the received dose of bilateral lungs and the maximally received dose of spinal marrow.Compared the effects of length and dose of tumor,V20(volume of 20Gy)of lung and Dmax(The Max dose)of spinal marrow on short-term curative effect and acute adverse reaction.And compared the effects of radiotherapy method for treatment expense and treatment times of patients.Results:The differences of short-term curative effect and long-term survivability between high dose group and low dose group were no significant(P>0.05),respectively.Radiation pneumonia was correlated with received dose of bilateral lung,the dose of tumor and the length of tumor.And myelosuppression was correlated with the dose at maximal point,the dose of tumor and the length of tumor.The re was no statistic difference.Conclusion:Within the range of adopted doses,high dose does not obtain high benefit for patients with esophageal carcinoma who receive radiotherapy,and high dose for tumor would lead to more severe adverse reactions.Acute side reactions of radiotherapy are mainly affected by the dose and length of tumors.