超分割放射治疗食管癌的远期疗效和预后分析

Long-term result and prognostic analysis of accelerated hyperfractionated radi o therapy for esophageal carcinoma

目的 对比研究全程加速超分割 (CAHF)和后程加速超分割 (LCAF)放射治疗食管癌的远期疗效并进行多因素预后分析。方法 对 1 0 1例食管鳞癌患者进行前瞻性随机分组研究 ,其中49例进入CAHF组 ,52例进入LCAF组。CAHF组治疗开始 1 .5Gy/次 ,2次 /d ,5d/周 ,照射 39Gy,2 6分次后缩野继续上述方式治疗 ;总量 66Gy,44次 ,4.3周完成。LCAF组开始为常规分割 1 .8Gy/次 ,1次 /d ,5d/周 ,照射至 41 .4Gy,2 3分次缩野改为 1 .5Gy/次 ,2次 /d ;2次照射相隔≥ 6h,5d/周 ,总剂量68.4Gy,41分次 ,6 .4周完成。结果 1、2、3、4、5年局部控制率CAHF组分别为 85 .9%、83 .1 %、72 .6 %、72 .6 %、72 .6 % ,LCAF组分别为 81 .3 %、69.6 %、67.1 %、67.1 %、67.1 % ,2个组差别无显著性意义 (P =0 .37)。CAHF组中位复发时间为 1 0 .0个月 ,LCAF组为 7.5个月。 1、2、3、4、5年生存率CAHF组分别为 77.6 %、55 .1 %、42 .9%、37.5 %、37.5 % ,LCAF组分别为 82 .4%、58.8%、49.0 %、49 .0 %、39.2 % ,2个组差别无显著性意义 (P =0 .46)。 1、2、3、4、5年无瘤生存率CAHF组分别为64 .8%、51 .4%、35 .8%、35 .8%、35 .8% ,LCAF组分别为 66 .0 %、53 .9%、51 .8%、51 .8%、41 .5 % ,2个组差别无显著性意义 (P =0 .34)。

Objective To evaluate the long-term treatment result and prognostic f actors of whole-course continual accelerated hyperfractionated (CAHF) and late -c ourse accelerated hyperfractionated (LCAF) radiotherapy for esophageal carcinoma . Methods From August 1995 to March 1998, a prospectively randomized trial was c arried out on 101 patients with squamous cell carcinoma of the esophagus which were randomized into two groups: 49 in the CAHF group and 52 in the LCAF group. Patients in the CAHF group received radiation at 1.5?Gy/fx , twice a day (in terva l of 6 hrs), 5 days per week , to a total dose of 66?Gy/44f/4.3 wks. Patients i n the LCAF group received conventional fractionation radiotherapy of 1.8 ?Gy per fr action to a dose of 41.4?Gy/23 f/4.6 wks , followed by accelerated fraction ation irradiation using reduced fields, twice daily at 1.5?Gy per fraction with a mini mum interval of 6 hours between fractions to a the total dose was 68.4?Gy/41 fx/ 6.4 wks . Results The local control rates at 1, 2, 3, 4 and 5 years were 85.9%, 83.1%, 72.6%, 72.6% and 72.6% in the CAHF group and 81.3%, 69.6%, 67.1%, 67.1% and 67.1% in the LCAF group ( P=0.37 ). The median relapse time was 10.0 months in CAHF group and 7.5 months in LCAF group. The 1-, 2- , 3-,4- and 5-year survival rates were 77.6%, 55.1%, 42.9% , 37.5% and 37.5% inthe CAHF group and 82.4% , 58.8%, 49.0%, 49.0% and 39.2% in the LCAF group (P=0.46 ). The 5-year tumor-fr ee survival rates were 64.8%, 51.4%, 35.8% , 35.8% and 35.8% in CAHF group and 66 .0%, 53.9%, 51.8%, 51.8% and 41.5% in LCAF group,with the difference insignific ant (P=0.34). The main common late reactions were lung fibrosis and esophageal stricture. In the CAHF arm, 16 of 29 patients died of distant metastasis; In the LCAF arm, 15 of 28 died of distant metastasis. Circumferential involvement and tumor response at the completion of radiotherapy were demonstrated to be indepen dent prognostic variables influencing the control rate by Cox regression model. And circumferential involvement, tumor response, T classification and age had in dependent prognostic value on long survival. Conclusions Continual accelerated hyperfractionated (CAHF) and late-course accelerated hyperfractionated (LCAF) r a diotherapy possess similar long-term result and late reaction. Circumferential i nvolvement and tumor response at the completion of radiotherapy are independent prognostic variables influencing the control rate by Cox regression model. And c ircumferential involvement, tumor response, T classification and age possess ind ependent prognostic value on the remote survival.