后程加速超分割放射治疗及其辅加化疗对中晚期食管癌的疗效对比观察

目的比较单纯后程加速超分割放射治疗及后程加速超分割放射治疗辅加化疗治疗食管癌的疗效与毒副反应。方法将162例食管癌患者随机分为2个组:①后程加速超分割放疗组(简称单放组,LCAFR),80例。治疗方案:常规分割30 Gy+加速超分割(1.5 Gy/次,2次/天,间隔≥6 h),总剂量为63 Gy;②后程加速超分割放疗辅加化疗组(简称综合组,LCAFR+C),82例。治疗方案:在后程加速超分割放疗(LCAFR)的同期加用顺铂(DDP)20 mg、氟脲嘧啶(5-Fu)500 mg、亚叶酸钙(CF)0.2 g,连用5天为1个周期,分别在第1、4周实施,共2个周期。结果单放组和综合组的1、2、3年生存率分别为53.8%(43/80)、35.0%(28/80)、25.0%(20/80)和79.3%(65/82)、54.8%(45/82)、43.9%(36/82),2组有显著性差异(χ2=10.33,P<0.01;χ2=5.61,P<0.05;χ2=5.65,P<0.05)。2组患者的死亡原因均以肿瘤局部未控制和复发为主。综合组因肿瘤局部未控制和复发的死亡率(50.0%,18/36)明显低于单放组(75.0%,45/60),2组比较有显著性差异(χ2=6.18,P<0.05)。2组治疗的急性毒副反应以消化系统及造血系统毒副反应为主,综合组急性毒副反应发生率Ⅲ度消化系统为(18.3%,15/82)高于单放组,但无显著性差异。结论后程加速超分割放射治疗辅加化疗能显著提高食管癌患者的3年生存率,虽毒性增加但可以耐受。

Evaluation of whole-course three-dimensional conformal radiotherapy combined with late-course accelerated hyperfractionated radiotherapy for esophageal carcinoma patients

Objective： The aim of the study was to evaluate the therapeutic effect and safety of whole-course three-dimensional conformal radiotherapy （3DCRT） combined with late-course accelerated hyperfractionated radiotherapy （LCAFR） on patients with esophageal carcinoma. Methods： one hundred and one patients with esophageal carcinoma were divided into two groups. Observing group （49 cases） were treated by whole-course 3DCRT. Patients in control group （52 cases） were treated by conventional radiotherapy. Clinical efficiencies and radiation toxicities were compared between two groups. Results： The side effects including radiation esophagitis （63.2%） and tracheitis （49.0%） decreased in observing group, but there was no significant difference between two groups （69.2% and 55.7% in controls）. The 1-, 2-and 3-year tumor local control rates and overall survival rates in the observing group were significantly improved compared with the control group, being respectively 87.8%, 75.5%, 63.3% vs 71.2%, 55.8%, 42.3% and 85.7%, 71.4%, 46.7% vs 69.2%, 51.9%, 26.9% （all P 0.05）. Conclusion： The therapeutic effect of whole-course 3DCRT combined with LCAFR for esophageal carcinomas is superior to conventional radiotherapy.

后程加速超分割三维适形放疗食管癌的疗效与不良反应分析

目的 探讨后程加速超分割三维适形放疗食管癌的疗效与不良反应.方法 对笔者医院2010年3月～2013年3月期间收治的两组共160例食管癌患者,分为对照组和观察组,观察组行三维适形放疗和后程加速超分割联合治疗,放疗组采用后程加速超分割放疗法,对两组患者的疗效和治疗方法的安全性进行评价.结果 观察组治疗有效率（RR）达到90.0％,对照组治疗有效率为72.5％,两组比较具有统计学差异（P＜0.05）.观察组患者3年局部控制率和生存率为分别为67.5％（54/80）和52.5％（42/80）,对照组为42.5％（34/80）和35.0％（28/80）,两组比较具有统计学差异（P＜0.05）.对照组急性放射性食管炎及气管炎的不良反应发生率为82.5％和62.5％,观察组为55.0％和45.0％.结论 后程超分割三维适形放疗对于局部食管癌患者近期疗效及生存率均有提高,并且较常规后程超分割疗法引发较轻的不良反应.