The follow-up of 34 children with medulloblastoma who received 3-dimensional conformal radiation therapy

Objective:In our investigation,we studied the patients with medulloblastoma who received 3-dimensional conformal radiation therapy(3DCRT) and recorded their effects,side effects and failure reasons.Methods:From August 2001 to August 2007,34 children with medulloblastoma were treated in our hospital.The age at diagnosis was 3-16 years old,and the mean age at diagnosis was 9.5 years old.Among all the patients,16 cases were included in the high risk group and 18 cases were included in the low risk group.All the patients were performed total resection or subtotal resection and no patients received radiotherapy or chemotherapy before operation.All patients received 3DCRT within 3 weeks after resection.The dose of 30 Gy were given to the whole brain and whole spine,followed by 20-25 Gy boosted to the posterior brain fossa.The median fraction dose was 180 cGy.Every patient received the chemotherapy scheme of the Lomustine,Cisplatinum and Vincristine.Nobody received intrathecal chemotherapy.The tests of the complete blood count,blood biochemistry,hepatic and renal functions were required before every cycle of chemotherapy.Results:5-year overall survival(OS) and 5-year disease free survival(DFS) were 71% and 62% respectively.The median follow-up time was 36.5 months.The 5-year OS of the high risk group was 71% compared to 62% of the low risk group.There were significant difference between the two groups(P = 0.01).There were 13 failure cases in all the patients.Of these 13 patients,10 were dead and the other 3 were alive with tumor.The complete remission(CR) rate was 70.5% and the partial remission(PR) rate was 14%.Among the failure patients,there were 3 patients(8.8%) with the recurrences located in the brain of cribriform region.The 5-year OS of the patients with preoperative metastases was 12.5%(1/8),and which of the patients with residual tumor volume > 1.5 cm3 was 0%(0/5).Through the statistic analysis,it was found that both whether or not the metastases were found before surgery and residual tumor volume have the significant impacts on the prognosis of the children with medulloblastoma(P < 0.05).The major adverse reactions were hematological toxicity(7/34,20.6%) and gastrointestinal reaction(4/34,11.8%).Conclusion:Through the using of 3DCRT for the children with medulloblastoma,the severe side effects rate was not high.The prognosis of the patients in low risk group was satisfied which was opposite to that of the patients in high risk group.And the patients with residual tumor volume > 1.5 cm3 and preoperative metastases also had poor prognosis.It is needed to pay attention to the possible low dose of the brain of cribriform region.

A dosimetric comparative study between conformal and intensity modulated radiation therapy in the treatment of primary nasopharyngeal carcinomas: the Egyptian experience

Objective: The study is a comparative study, the aim of which is to compare 3D conformal radiation therapy (3D-CRT) and intensity modulated radiation therapy (IMRT) in treating nasopharyngeal carcinomas; dosimetrically evaluating and comparing both techniques as regard target coverage and doses to organs at risk (OAR). Methods: Twenty patients with nasopharyngeal carcinoma were treated by 3D-CRT technique and another 20 patients were treated by IMRT. A dosimetric comparison was done by performing two plans for the same patient using Eclipse planning system (version 8.6). Results: IMRT had a better tumor coverage and conformity index compared to 3D-CRT plans (P value of 0.001 and 0.004), respectively. As for the dose homogeneity it was also better in the IMRT plans and the reason for this was attributed to the dose inhomogeneity at the photon/electron junction in the 3D-CRT plans (P value 0.032). Also, doses received by the risk structures, particularly parotids, was significantly less in the IMRT plans than those of 3D-CRT (P value 0.001). Conclusion: IMRT technique was clearly able to increase the dose delivery to the target volume, improve conformity and homogeneity index and spare the parotid glands in comparison to 3D-CRT technique.

Influences of Motion Artifacts on Three-Dimensional Reconstruction Volume and Conformal Radiotherapy Planning

Objective ：To investigate the influences of motion artifacts on three-dimensional （3D） reconstruction volume and conformal radiotherapy planning. Methods： A phantom which can mimic the clip motion of lung tumor along the cranial-caudal direction is constructed by step motor, small ball of polyethylene and potato. Ten different scan protocols were set and CT data of the phantom were acquired by using a commercial GE LightSpeedl6 CT scanner. The 3D reconstruction of the CT data was implemented by adopting volume-rendering technology of GE AdvantageSim 6.0 system. The reconstructed volumes of each target in different scan protocols were measured through 3D measuring tools. Thus, relative deviations of the reconstruction volumes between moving targets and static ones were determined. The three-dimensional conformal radiation therapy （3D- CRT） plans and conformal fields were created and compared for a static/moving target with the WiMRT treatment planning system （TPS）. Results：For a static target, there was no obvious difference among the 3D reconstruction volumes when the CT data were acquired with different pitches and slices. The appearance of 3D reconstruction volume and 3D conformal field of a moving target was quite different from that of static one. The maximum relative deviation is nearly 90% for a moving target scanned with different scan protocols. The relative deviations are variable among the different targets, about from -39.8% to 89.5% for a smaller target and from - 18.4% to 20.5% for a larger one. Conclusion ：The motion artifacts have great effects on 3 D-CRT planning and reconstruction volume, which will greatly induce distorted conformal radiation fields and false DVHs for a moving target.

Role of radiation therapy in gastric adenocarcinoma

Outcomes in patients with gastric cancer in the United States remain disappointing, with a five-year overall survival rate of approximately 23%. Given high rates of local-regional control following surgery, a strong rationale exists for the use of adjuvant radiation therapy. Randomized trials have shown superior local control with adjuvant radiotherapy and improved overall survival with adjuvant chemoradiation. The benefit of adjuvant chemoradiation in patients who have undergone D2 lymph node dissection by an experienced surgeon is not known, and the benefit of adjuvant radiation therapy in addition to adjuvant chemotherapy continues to be defined. In unresectable disease, chemoradiation allows long-term survival in a small number of patients and provides effective palliation. Most trials show a benefit to combined modality therapy compared to chemotherapy or radiation therapy alone. The use of pre-operative, intra-operative, 3D conformal, and intensity modulated radiation therapy in gastric cancer is promising but requires further study. The current article reviews the role of radiation therapy in the treatment of resectable and unresectable gastric carcinoma, focusing on current recommendations in the United States.

3DCRT技术治疗原发性肝癌的临床剂量学研究

目的探讨3DCRT技术治疗原发性肝癌的方法、处方剂量与疗效的关系。方法27例有随访结果的肝癌患者,对其肿瘤体积大小、位置、处方剂量及生存期作回顾性总结。结果治疗后肿瘤局部控制率为85.2%(23/27),1年生存率为70.4%(19/27),2年生存率为55.6%(15/27),3年生存率为33.3%(9/27)。所有病人无放射性肝炎等严重副反应发生。结论3DCRT技术治疗不宜手术的肝癌是一种无创而有效的治疗方法,可提高肝癌的局部控制率,不良反应轻微,病人生存质量得到提高。

3D-CRT与静态IMRT在局部晚期非小细胞肺癌治疗中的效果及安全性分析

目的:探讨三维适形放疗(3-dimensional conformal radiation therapy,3D-CRT)与静态调强放疗(intensity modulated radiation therapy,IMRT)在局部晚期非小细胞肺癌(locally advanced non-small cell lung cancer,LANSCLC)治疗中的效果及安全性。方法:选取2017年1月-2019年6月就诊于本院的82例LANSCLC患者,按随机数字表法将其分为A、B组,各41例。A组行静态IMRT,B组行3D-CRT。比较两组治疗效果、计划靶区剂量及治疗安全性。结果:两组治疗总有效率与平均剂量比较,差异均无统计学意义(P>0.05)。A组不均匀性指数(HI)高于B组,而适形指数(CI)水平低于对照组(P<0.05)。A组>Ⅲ度放射性食管炎、血小板减少、>Ⅲ度白细胞减少、>Ⅲ度放射性肺炎及>Ⅲ度消化道反应发生率均低于B组(P<0.05)。结论:3D-CRT与静态IMRT在LANSCLC治疗中的效果相似,但静态IMRT靶区剂量分布更优,能减少放疗毒副反应发生,而其低剂量区照射体积增大,需加以注意。

3DCRT治疗中不同部位恶性肿瘤外周血免疫细胞的动态变化

目的 探讨 3D立体定向适形放射治疗 (3D CRT)前后不同部位恶性肿瘤患者T ,B淋巴细胞和NK细胞的变化。方法 应用流式细胞技术对 4 3例恶性肿瘤患者在 3D CRT前和后 1,4周外周血CD3 ,CD4,CD8细胞 ,CD4/CD8比值 ,CD19细胞和NK细胞的变化。结果 (1)不同部位恶性肿瘤患者 3D CRT前CD3 ,CD4细胞 ,CD4/CD8比值 ,CD19及NK细胞均显著低于健康组 (P <0 .0 5 ,P <0 .0 1) ;(2 )照射后食管癌和直肠癌CD3 ,CD4细胞及CD4/CD8比值下降不明显 ,第4周时已回升 (P >0 .0 5 ) ;脑胶质瘤照射前后变化不显著 (P >0 .0 5 )。 (3)各类肿瘤照射期间CD19细胞、NK细胞无明显下降 (P >0 .0 5 )。结论 恶性肿瘤患者因 3D CRT治疗部位不同 ,其免疫功能细胞的改变有差异 ,临床可据此调整照射剂量、剂量分割及药物对抗。此外 ,CD19细胞和NK细胞对放疗的不敏感性是 3D

三维适形与3D辅助腔内后装放疗治疗中晚期宫颈癌的临床疗效

目的探究三维适形与3D辅助腔内后装放疗治疗中晚期宫颈癌的临床疗效。方法选取2019年7月至2020年7月于本院就诊的72例中晚期宫颈癌患者作为研究对象,按照随机分组法分为观察组、对照组,每组36例。对照组采用三维调强放疗联合二维腔内后装治疗,观察组则采用三维调强放疗联合3D辅助腔内后装放疗方式,两组均给予顺铂治疗。比较两组临床疗效和急性不良反应(血管异常、泌尿系损伤如放射性膀胱炎及消化道损伤)发生情况。结果观察组治疗总有效率为97.22%,高于对照组的83.33%,差异有统计学意义(P<0.05);观察组血象异常总发生率为33.33%、泌尿系统损伤总发生率为25.00%、消化道损伤总发生率为22.22%,均低于对照组的58.33%、47.22%、47.22%,差异有统计学意义(P<0.05)。结论三维适形放疗与3D辅助腔内后装放疗治疗中晚期宫颈癌疗效确切,可减少急性不良反应发生情况,安全性较高,促进患者康复,值得临床推广应用。

颈静脉球瘤的三维立体适形放疗3例报告

目的:探讨三维立体适形放疗治疗颈静脉球瘤的临床疗效。方法:回顾性分析3例颈静脉球瘤的临床资料,3例均采用三维立体适形放疗,肿瘤体积约2-8cm3,肿瘤DT达45-55Gy/9-11f/3-3.5w,随访1-8年。结果:1例头痛、头晕、耳鸣、耳聋等症状完全缓解,复查颅脑增强MRI显示病灶明显缩小;1例耳鸣、头痛、头晕、手足震颤、出汗均消失,继发性高血压自愈,复查颅脑增强MRI显示病灶缩小;1例耳鸣减轻,颅脑CT显示肿瘤稳定。随访后病情均稳定,无复发或转移。结论:三维立体适形放疗能较好的控制肿瘤生长,无明显不良反应,可作为不适合手术、拒绝手术的颈静脉球瘤病人首选的治疗方法,同时也是术后肿瘤残留或复发的重要治疗手段。

3种放疗治疗食管癌近期疗效分析

目的探讨常规(CF)、三维适形(3DCRT)和调强(IMRT)放疗治疗食管癌的近期疗效及放疗反应。方法选择2006年9月～2008年1月我院收治的食管癌患者中行单纯放疗的患者共149例,其中采用常规放疗68例(CF组),三维适形放疗45例(3DCRT组),调强放疗36例(IMRT组),均采用6MVX线照射,2.0Gy/次,5次/周,总剂量为60～66Gy、分30～33次、40～45d完成,比较3组的近期疗效及放疗反应。结果 CF组、3DCRT组和IMRT组有效率分别为70.6%、91.1%和91.7%。CF组与3DCRT组和IMRT组有效率差异有统计学意义(P<0.05～0.01)。各临床分期近期疗效差异有统计学意义(P<0.01)。3组1年局部控制率分别为55.4%、70.5%和69.4%;3组2年局部控制率分别为30.8%、50.0%和58.3%;3组1年生存率分别为75.4%、84.1%和83.3%;3组2年生存率分别为33.8%、54.6%和58.3%。3DCRT组+IMRT组放射性食管炎发生率较CF组高(P<0.05),放射性肺炎发生率CF组较IMRT组+3DCRT组高(P<0.05),骨髓抑制反应3DCRT组+IMRT组较CF组轻(P<0.05)。结论 3DCRT和IMRT方法能提高食管癌的临床疗效,放射反应均可耐受。

Dosimetric evaluation of CR, 3DCRT and two types of IMRT for breast cancer after conservative surgery

Objective: The purpose of this study was to compare the dose distribution and dose volume histogram (DVH) of the planning target volume (PTV) and organs at risk (OARs) among conventional radiation therapy (CR), three-dimensional conformal radiation therapy (3DCRT), two-step intensity-modulated radiation therapy (TS-IMRT) and direct machine parameter optimization intensity-modulated radiation therapy (DMPO-IMRT) after breast-conserving surgery. Methods: For each of 20 randomly chosen patients, 4 plans were designed using 4 irradiation techniques. The prescribed dose was 50 Gy/2 Gy/25 f, 95% of the planning target volume received this dose. The cumulated DVHs and 3D dose distributions of CR, 3DCRT, TS-IMRT and DMPO-IMRT plans were compared. Results: For the homogeneity indices, no statistically significant difference was observed among CR, 3DCRT, TS-IMRT and DMPO-IMRT while the difference of the conformality indices were statistically significant. With regard to the organs at risk, IMRT and 3DCRT showed a significantly fewer exposure dose to the ipsilateral lung than CR in the high-dose area while in the low-dose area, IMRT demonstrated a significant increase of exposure dose to ipsilateral lung, heart and contralateral breast compared with 3DCRT and CR. In addition, the monitor units (MUs) for DMPO-IMRT were approximately 26% more than those of TS-IMRT and the segments of the former were approximately 24% less than those of the latter. Conclusion: Compared with CR, 3DCRT and IMRT improved the homogeneity and conformity of PTV, reduced the irradiated volume of OARs in high dose area but IMRT increased the irradiated volume of OARs in low dose area. DMPO-IMRT plan has fewer delivery time but more MUs than TS-IMRT.

The impact of intensity modulated radiotherapy on the skin dose for deep seated tumors

Objective: The purpose of this study was to investigate the impact of intensity modulated radiotherapy (IMRT) on surface doses for brain, abdomen and pelvis deep located tumors treated with 6 MV photon and to evaluate the skin dose calculation accuracy of the XIO 4.04 treatment planning system. Methods: More investigations for the influences of IMRT on skin doses would increase its applications for many treatment sites. Measuring skin doses in real treatment situations would reduce the uncertainty of skin dose prediction. In this work a pediatric human phantom was covered by a layer of 1 mm bolus at three treatment sites and thermoluminescent dosimeter (TLD) chips were inserted into the bolus at each treatment site before CT scan. Two different treatment plans [three-dimensional conformal radiation therapy (3DCRT) and IMRT] for each treatment sites were performed on XIO 4.04 treatment planning system using superposition algorism. Results: The results showed that the surface doses for 3DCRT were higher than the surface doses in IMRT by 1.6%, 2.5% and 3.2% for brain, abdomen and pelvis sites respectively. There was good agreement between measured and calculated surface doses, where the calculated surface dose was 15.5% for brain tumor calculated with 3DCRT whereas the measured surface dose was 12.1%. For abdomen site the calculated surface dose for IMRT treatment plan was 16.5% whereas the measured surface dose was 12.6%. Conclusion: The skin dose in IMRT for deep seated tumors is lower than that in 3DCRT which is another advantage for the IMRT. The TLD readings showed that the difference between the calculated and measured point dose is negligible. The superposition calculation algorism of the XIO 4.04 treatment planning system modeled the superficial dose well.

140例局部复发鼻咽癌患者三维适形放疗的疗效分析

背景与目的:局部复发鼻咽癌再次放疗的方式很多,但常规放疗后良反应大,目前关于三维适形放疗(three dimensional conformal radiation therapy,3D-CRT)治疗复发鼻咽癌的报道较少,本研究旨在分析3D-CRT对140例局部复发鼻咽癌患者的疗效及其不良反应。方法:本院于1997年5月—2009年6月对140例经病理活检和(或)通过CT/MRI证实颅底病变或颅神经症状进展而确诊为局部复发的鼻咽癌患者采用3D-CRT治疗。患者中位复发时间为27.5个月(1～156个月),50.7%患者的复发为T3-4期,患者3D-CRT治疗的最小计划放疗剂量是GTV-P为DT 59.4 Gy/1.8～2 Gy(联合或不联合化疗)。结果:复发后中位照射剂量是62 Gy(39～82 Gy);中位随访时间25.5个月(3～135个月),随访率100%。3、5年的总生存率(overall survival,OS),无瘤生存率(disease-free survival,DFS),局部控制率(locoregional recurrence-free survival,LRRFS)分别为44.53%vs 31%,42.82%vs 29.13%,44.19%vs 30.76%。48例患者(34.3%)出现中重度并发症,其中鼻咽溃疡13例(9.29%),颅神经损伤21例(15%),张口困难20例(14.3%),听力下降16例(11.4%)。多因素分析显示年龄是独立的预后不良因素。结论:采用3D-CRT对局部复发鼻咽癌安全、有效,不良反应可以耐受。

早期乳腺癌保乳术后部分乳腺三维适形加速外照射剂量学研究

【目的】本研究通过对早期乳腺癌保乳术后部分乳腺三维适形加速外照射(APBI-3DCRT)计划设计的研究,旨在探讨中国女性早期乳腺癌保乳术后APBI-3DCRT剂量学分布特点及剂量学的可行性。【方法】选择50例保乳术后T1～2N0M0病例,利用三维治疗计划系统设计APBI-3DCRT计划及全乳腺照射(WBI)计划。按RTOG0319标准对50例APBI-3DCRT计划进行剂量学可行性评价;并比较正常组织在APBI-3DCRT和WBI计划中受量情况。【结果】50例APBI-3DCRT计划中评为Ⅰ级1例(2%);Ⅱ级46例(92%);Ⅲ级3例(6%)。与WBI相比,评价为Ⅰ～Ⅱ级APBI-3DCRT计划的患侧肺平均剂量(Dmean)以及至少接受20 Gy照射的体积百分比(V20)分别从9.259 Gy减少至1.637 Gy和从15.53%到1.79%,心脏的Dmean和V20分别从1.826 Gy减少至0.305 Gy和从3.14%到0.04%,对侧肺的最大剂量(Dmax)和Dmean分别从2.809 Gy减少至0.236 Gy和从1.107 Gy到0.102 Gy,对侧乳腺的Dmax和Dmean分别从2.391 Gy减少至0.231 Gy和从0.984 Gy到0.098 Gy,甲状腺的Dmax和Dmean分别从0.494 Gy减少至0.203 Gy和从0.203 Gy到0.078 Gy(P<0.05)。【结论】与WBI相比,APBI-3DCRT可以减少正常组织受照射的体积及照射剂量,有利于减轻正常组织的放射损伤;中国女性早期乳腺癌保乳术后进行APBI-3DCRT在剂量学上是可行的,建议进行Ⅰ/Ⅱ期的临床研究。

食管癌术后三种放疗方案的对比研究

目的：对比研究调强适形放疗（IMRT）、三维适形放疗（3DCRT）和常规模拟机定位放疗等3种不同方法在食管癌术后预防照射中的优缺点.方法：15例食管癌术后患者采用IMRT方法进行治疗,应用同一治疗计划系统,制订模拟适形放疗和常规模拟机定位放疗方案,3种方案照射剂量均为1.8～2.0Gy/次,5次/周,50Gy/5～6周.结果：与3DCRT和常规模拟机定位放疗相比,食管癌术后照射中IMRT有最好的剂量分布,既可明显提高靶区的剂量,同时能较好地保护正常组织. 结论：食管癌术后采用IMRT优于3DCRT和常规模拟机放疗,是目前最佳的一种放疗方法.

联合检测血清VEGF、CA125和CEA对41例中晚期肺癌患者三维适形放疗疗效评估价值

目的探讨联合检测中晚期肺癌患者血清血管内皮生长因子(VEGF)、癌抗原125(CA125)和癌胚抗原(CEA)在三维适形放疗疗效评估中的价值。方法采用酶联免疫吸附实验(ELISA)和(或)免疫放射分析法(IRMA)测定41例中晚期肺癌患者放疗前、后及放疗后2个月血清VEGF、CA125和CEA水平,以25例健康者测定值为对照。结果肺癌组血清VEGF、CA125和CEA明显高于对照组,肺癌组VEGF、CA125和CEA在放疗后均低于放疗前(P<0.05)。结论联合检测血清VEGF、CA125和CEA对中晚期肺癌患者病情变化及估计预后有一定的参考价值,血清中VEGF、CA125和CEA水平与肺癌病情变化呈负相关。

胸上段食管癌调强放疗和三维适形放疗剂量学研究

目的:比较分析胸上段食管癌调强适形(IMRT)放疗和三维适形(3D-CRT)放疗的剂量学差异。方法:选择10例胸上段食管癌患者,应用三维治疗计划系统(TPS)分别为每例患者设计2种治疗计划(A:调强适形放疗;B:三维适形放疗),在规定PTV至少达到95%处方剂量前提下根据体积直方图(DVH)比较2种计划靶区剂量分布及脊髓、肺、心脏等正常组织受量的差异。结果:2种计划的靶区适形度指数(CI)、均匀性指数(HI)、处方剂量覆盖PTV百分比均以IM-RT计划为好,IMRT同时减少了脊髓最大所受剂量,差异均有统计学意义(P<0.05);2种计划的双肺受照剂量V20、心脏平均剂量均在可耐受的范围内,差异无统计学意义(P>0.05)。结论:胸上段食管癌采用IMRT优于3DCRT放疗,是目前较好的一种放疗方法。

晚期胆管癌24例疗效分析

目的：晚期不能手术胆管癌患者，目前仍未有统一的治疗标准。本文将回顾性分析晚期不能手术的胆管癌的治疗效果并探讨其治疗策略。方法：1986年～2003年本院收治的晚期不能手术的胆管癌患者24例，其中21例（87．5％）治疗前行胆道减压术。接受传统的常规外照射（常规组）14例，三维适形放疗（适形组）10例，其中配合全身化疗5例均为出现淋巴结或远处转移者。结果：（1）全组有效率75．0％，其中适形组和常规组的局部完全缓解率分别为50．0％（5／10）、7．1％（1／14）（P=0．05）；总胆红素转为正常者79．2％（19／24）。（2）全组平均生存时间为11．0个月，6、12、18、24个月生存率分别为62．5％、37．5％、12．5％、4．2％。其中，适形组和常规组的平均生存时间分别为17．2和6．7个月（P〈0．001）。（3）放疗毒副反应可以接受，两组的发生率相仿。（4）60Gy以上和小于60Gy的平均生存时间分别为18．0和6．9个月（P〈0．001）。（5）配合化疗患者近期疗效满意。结论：（1）放疗是晚期胆管癌的主要治疗手段，适形放疗进一步提高局控率和生存率，可常规应用。（2）联合放、化疗可能有益于提高疗效。（3）生存时间与放疗剂量呈正相关，为提高局控率及生存率，可考虑联合应用外照射与腔内放疗。

Ⅰ期原发性肝癌三维适形放疗的疗效评价和预后多因素分析

目的评价三维适形放疗(3-dimensional conformal radiation therapy,3-DCRT)对Ⅰ期原发性肝癌治疗疗效及其影响预后的因素分析。方法对41例Ⅰ期原发性肝癌患者行三维适形放疗,用kap-lan-Meier统计累积生存率、COX回归模型对预后进行单、多因素分析。结果1、2、3年累积生存率分别为95.1%、90.2%、80.5%。平均生存时间49.5月。中位生存时间56个月。治疗副反应轻微。多因素回归分析显示仅肿瘤数目对患者生存期的影响有统计学意义(P<0.05)。结论三维适形放疗对Ⅰ期原发性肝癌患者的治疗是安全、有效的手段,肿瘤数目、肿瘤直径是影响预后的主要因素。

食管癌术后纵隔转移灶后程加速超分割三维适形放射治疗

目的:探讨胸段食管癌根治术后纵隔转移灶后程加速超分割三维适形放射治疗的意义和效果。方法:104例食管癌根治术后发生纵隔转移患者,随机分为常规治疗组和研究组。开始治疗时两组均采用前后两野同照放射治疗,分割剂量DT2.0Gy/次,5次/周,照射38Gy后常规组根据CT复查情况重新模拟机定位,两野或者三野避脊髓继续常规分割治疗。研究组行CTsim定位,进行三维适形计划设计,新计划以DT1.5Gy/次,2次/d,5天/周,常规组照射目标剂量60Gy,研究组照射目标剂量68Gy。结果:治疗后3个月复查CT,各组病灶达CR者14//29例,分别占26.9%和55.8%,各组病灶达PR者26/22例,分别占50.0%和42.3%,两组总的有效率(CR+PR)分别是76.9%和98.1%。结论:食管癌根治术后纵隔转移患者进行后程加速超分割三维适形放射治疗可以明显提高局部控制率,疗效达CR和CR+PR的患者均有统计学差异(P≤0.005和P≤0.05),急性放射治疗反应可耐受,具有良好的应用前景。