食管癌调强放射治疗结合Ir192高剂量率后装治疗的疗效及安全性研究

Efficacy and safety of intensity-modulated radiotherapy combined with Ir192 high dose rate brachytherapy for esophageal cancer

目的评价食管癌调强放射治疗结合Ir192高剂量率后装治疗的疗效和安全性。方法收集金华市中心医院2010至2017年食管癌放射治疗患者216例,分为调强放射治疗组(对照组)156例,调强放射治疗结合Ir192高剂量率后装治疗组(研究组)60例,根据随访结果统计1、3、5年总生存率,根据住院期间电子病历记载统计3级以上放射性食管炎及放射性肺炎发生率。结果对照组与研究组的1、3、5年总生存率分别为69%、31%、13%及83%、52%、27%,差异有统计学意义(P<0.05),后装加量的总生存率优于调强放射治疗。3级以上放射性食管炎及放射性肺炎发生率差异无统计学意义(P>0.05)。Cox比例风险回归模型多因素分析提示,性别和是否结合Ir192高剂量率后装治疗是食管癌患者总生存时间(OS)的影响因素(均P<0.05)。结论食管癌调强放射治疗结合Ir192高剂量率后装治疗能提高食管癌放射治疗疗效,安全性良好。

Objective To evaluate the efficacy and safety of intensity-modulated radiotherapy(IMRT)combined with Ir192 high dose rate brachytherapy in treatment of esophageal cancer.Methods Two hundred and sixteen patients with esophageal cancer undergoing radiotherapy in Jinhua central hospital from 2010 to 2017 were included in the study,among whom 156 cases received conventional IMRT(IMRT group),60 cases received IMRT combined with Ir192 high dose rate brachytherapy(combination group).The 1-,3-and 5-year overall survival rate,the incidence of radiation esophagitis and radiation pneumonitis of grade 3 or above was documented and compared between two groups.Results The 1-,3-and 5-year overall survival rates of IMRT group and combination group were 69%,31%,13%and 83%,52%,27%,respectively(P<0.05).There was no significant difference in the incidence of radiation esophagitis and radiation pneumonitis between two groups.Multivariate analysis suggested that sex and combination therapy were the influencing factors for overall survival of esophageal cancer patients(P<0.05).Conclusion The combination of IMRT with brachytherapy of Ir192 can improve the efficacy for esophageal cancer with safety.