三维立体适形放射治疗技术治疗食管癌的初步观察

PRELIMINARY OBSERVATION OF 3-DIMENSIONAL CONFORMAL RADIOTHERAPY FOR ESOPHAGEAL CARCINOMA

目的分析和观察三维适形放射治疗技术治疗食管癌的治疗反应和近期疗效。方法对 13例食管癌患者用三维适形放射治疗技术进行治疗 ,所有患者均为首治病例 ,其中 8例应用常规放射治疗技术加三维适形放射治疗技术治疗 ,5例只用三维适形放射治疗技术进行放射治疗。处方剂量 6 0 0 0～ 6 6 0 0cGy ,分割剂量 180～ 2 0 0cGy/次 ,1次 /d ,5次 /周 ;或 4 0 0cGy/次 ,隔日 1次 ,3次 /周。照射剂量参考线为 90 %等剂量曲线。结果进食改善率为 76 .9% (10 / 13) ,近期有效率为 10 0 % (13/ 13) ;急性放射性食管炎发生率为 5 3.8% (7/ 13) ,晚期食管并发症发生率为 4 6 .2 % (6 / 13) ,主要包括食管狭窄和溃疡 ,出现时间为放射治疗开始后 4～ 14个月。结论用三维立体适形放射治疗食管癌是可行的 ;大分割放射治疗不适于食管癌的放射治疗 ,可以增加晚期并发症 ,影响患者的生存质量甚至生存期。

ObjectiveTo observe and evaluate the instant response and side effects of 3 dimensional conformal radiotherapy (3 DCRT) for the patients with esophageal carcinoma. MethodsThirteen patients with esophageal carcinoma were treated by 3 DCRT. All were never treated before. Eight were treated first by conventional radiotherapy then by 3 DCRT and five were treated only by 3 DCRT. The prescribed dose was from 6 000 to 6 600 cGy either with conventional fractionation (180-200 cGy a time, once a day, 5 times a week )or with hypofractionation (400 cGy once, a time every other day, 3 times a week). The reference dose curve was the isodose curve of 90 % . ResultsThe ameliorating rate for taking food was 76.9 % (10/13) and the response rates at the end of radiotherapy or 1 month after radiotherapy were 100 % respectively. The acute radiation esophagitis rate was 53.8 % (7/13), and the late complication rate for esophagus (including clinical stricture/perforation) was 46.2 % (6/13),mainly including esophageal stricture and ulcer,and they occurred 4-14 months after the radiotherapy.Conclusion 3 DCRT was feasible for esophageal carcinoma. Hypofractionated 3 DCRT was not suitable for esophageal carcinoma for it could increase the opportunity for late complication of esophagus and may deteriorate the living quality or even the life term.