胸上中段食管鳞癌后程加速超分割放射治疗随机研究结果

Randomized trial on late course accelerated hyperfractionation radiotherapy for squamous cell carcinoma of upper and mid-thoracic esophagus

目的 评价胸上、中段食管鳞癌后程加速超分割放射治疗的疗效。方法 82例胸上、中段食管鳞癌病例随机分为后程加速超分割 (后加速组 )和常规分割 (常规组 )两组。常规组总剂量 6 4～ 6 6Gy ,6 .5周完成。后加速组为前 3周采用常规分割 ,后 2周采用超分割方法 ,即 1.5Gy/次 ,2次 /d ,间隔 6h ,总剂量 6 0Gy ,5周完成。结果 2个组近期疗效比较无差别。后加速组 1、2、3、4年局部控制率分别为 6 8.3%、4 5 .0 %、4 5 .0 %、4 5 .0 % ,常规组分别为 5 2 .6 %、30 .1%、2 7.4 %、2 2 .8% ,2个组差异无显著性意义 (χ2 =3.0 1,P =0 .0 8)。后加速组 1、2、3、4年生存率分别为 73.2 %、4 2 .2 %、39 .4 %、31.3% ,常规组分别为 6 1.0 %、31.7%、2 6 .8%、19.6 % ,2个组差异无显著性意义 (χ2 =1.4 6 ,P=0 .2 2 )。后加速组中位复发时间为 11个月 ,常规组为 9个月 ,二者无差别 (P >0 .0 5 )。后加速组放射性食管炎发生率较常规组高 (P <0 .0 1) ,食欲下降发生率亦较常规组高 (P <0 .0 5 ) ,无中断病例。 2个组病例共死亡 5 9例 ,肿瘤复发和未控仍然是主要死亡原因。后加速组死亡 2 7例 ,除 4例远地转移和 1例非癌死亡外 ,其他 2 2例均和局部复发有关 ;常规组死亡 32例 ,除 2例远地转移外均和局部复发有关。?

Objective To evaluate the effect of late course accelerated hyperfractionation (LCAH)radiotherapy for squamous cell carcinoma of upper and mid-thoracic esophagus.Methods From December 1997 to September 1999, eighty-two eligible patients with squamous cell carcinoma of upper and mid-thoracic esophagus were randomized into two groups: the conventional fractionation(CF) and late course accelerated hyperfractionation(LCAH) groups. Patients in CF group received routine radiotherapy 2 ?Gy per day, 5 times a week, to a total dose of 64～66?Gy in 6.5 weeks. Patients in LCAH group first received 30 ?Gy by routine fractionation, then 1.5 ?Gy twice daily, with an interval of 6 hours between fractions, five days per week, to a total dose of 60?Gy in 5 weeks. Both groups were treated by 6 M X-rays or 60Co γ-rays. Results There were no significant difference in X-ray film evaluation right after or one month after the treatment between the two groups(P>0.05).The 1-,2-,3-,4-year local tumor control rates of LCAH group were obviously improved when compared to CF group, being 68.3%, 45.0%, 45.0%, 45.0% vs 52.6%, 30.1%, 27.4%, 22.8% (χ2=3.01, P= 0.08). The 1-,2-,3-,4-year survival rates were 73.2%, 42.2%, 39.4%, 31.3% in LCAH group and 61.0%, 31.7%, 26.8%, 19.6 in CF group. Though it was slightly better in the LCAH group than the CF group, the difference was not significant (χ2=1.46, P=0.22). The median relapse time was 11 months in LCAH and 9 months in CF group, which was prolonged in LCAH group, though without any statistical difference (P>0.05). The incidence of acute esophagitis was increased but it was acceptable in the LACF group (P<0.01), and all treatment plans could be completed without any interruption. Of the 59 patients who died, 27 were in LACF group and 32 in CF group. Of the 27 patients in LACF group who died, the death of 22 was related to local failure or uncontrolled lesions. Conclusions Late course accelerated hyperfractionation (LCAH) may improve the treatment results in squamous cell carcinoma of upper and mid-thoracic esophagus with acceptable acute reactions. Local failure or uncontrolled lesions are still the main cause of failure in LCAH. Total dose higher than 60?Gy in LCAH group is suggested and warrants further study.