Long-term outcomes and prognostic factors for patients with esophageal cancer following radiotherapy

AIM:To evaluate long-term outcomes and prognostic factors for esophageal squamous cell carcinoma(SCC) treated with three dimensional conformal radiotherapy(3D-CRT).METHODS:Between January 2005 and December 2006,153 patients(120 males,33 females) with pathologically confirmed esophageal SCC and treated with 3D-CRT in Cancer Hospital of Shantou University were included in this retrospective analysis.Median age was 60 years(range:37-84 years).The proportion of tumor location was as follows:upper thorax(including the cervical region),73(48%);middle thorax,73(48%);lower thorax,7(5%),respectively.The median radiation dose was 64 Gy(range:50-74 Gy).Fifty four cases(35%) received cisplatin-based concurrent chemotherapy.Univariate and multivariate analysis were performed to determine the association between the correlative factors and prognosis.RESULTS:The five-year overall survival rate was 26.3%,with a median follow-up of 49 mo(range:3-66 mo) for patients who were still alive.On univariate analysis,lesion location,lesion length by barium esophagogram,computed tomography imaging characteristics including Y diameter(anterior-posterior,AP,extent of tumor),gross tumor volume of primary lesion(GTV-E),volume of positive lymph nodes(GTV-LN),and the total target volume(GTV-T = GTV-E + GTVLN) were prognostic for overall survival.By multivariate analysis,only the Y diameter [hazard ratio(HR) 2.219,95%CI 1.141-4.316,P = 0.019] and the GTV-T(HR 1.372,95%CI 1.044-1.803,P = 0.023) were independent prognostic factors for survival.CONCLUSION:The overall survival of esophageal carcinoma patients undergoing 3D-CRT was promising.The best predictors for survival were GTV-T and Y diameter.

Radiotherapy of double primary esophageal carcinoma

INTRODUCTIONDouble primary esophageal carcinoma is defined ashaving two loci of squamous cell cancersimultaneously or consecutively developing indifferent sites of esophagus.This rare diseaseappears mostly in the literature as case reports,reports about its treatment are even moreinfrequent.Here we present our experiences

Radiotherapy combined with nimotuzumab for elderly esophageal cancer patients:A phaseⅡclinical trial

Objective:To investigate the safety and efficacy of nimotuzumab combined with radiotherapy for elderly patients with non-resectable esophageal carcinoma(EC).Methods:Eligible patients were aged 70 years or older and had treatment-naive,histologically proven inoperable locally advanced EC.Enrolled patients received radiotherapy with a total dose of 50-60 Gy in 25-30 fractions,concurrent with weekly infusion of nimotuzumab.The primary end point was the rate of more than grade 3 toxicities.Results:From June 2011 to July 2016,46 patients with stageⅡ-IV EC with a median age of 76.5 years were enrolled.There were 10,28 and 8 patients with stageⅡ,III and IV disease,respectively.The common acute toxicities included esophagitis(grade 1-2,75.4%;grade 3,8.7%),pneumonitis(grade 1,4.3%;grade 2,6.5%;grade3,2.2%),leukopenia(grade 1-2,60.9%;grade 3-4,4.4%),gastrointestinal reaction(grade 1-2,17.3%;grade 3,2.2%),thrombocytopenia(grade 1-2,21.7%;grade 3,2.2%),and radiothermitis(grade 1-2,39.2%).The incidence of grade 3-4 adverse effects was 17.4%.No grade 5 toxicities were observed.Clinical complete response,partial response,stable disease,and progressive disease were observed in 1(2.2%),31(67.4%),12(26.1%),and 2(4.3%)patients,respectively.The median overall survival(OS)and progression-free survival(PFS)were 17 and 10 months,respectively.The 2-,3-,and 5-year OS and PFS rates were 30.4%,21.7%,19.6%,and 26.1%,19.6%,19.6%,respectively.Conclusions:Nimotuzumab combined with radiotherapy is a safe and effective therapy for elderly patients who are not surgical candidates.Further studies are warranted to confirm its therapeutic effects in elderly EC patients.

Treatment guideline of radiotherapy for Chinese esophageal carcinoma (draft)

Esophageal carcinoma is one of the most common human cancers in China. Radiotherapy plays an important role in combination therapy of esophageal carcinoma. With regret, there is still no unified standard for the treatment of esophageal carcinoma in China, and there are many controversies in the treatment regimens, indications, methods and efficacy. Clinically, the clinical practice guidelines of the National Comprehensive Cancer Network (NCCN) of the United States were often consulted, but the data of them were mainly from the patients from Europe and America, and they might not be applicable for Chinese patients. In order to standardize clinical process of radiotherapy for esophageal carcinoma in China, the Esophageal Carcinoma Cooperative Group of Radiation Oncology Society of Chinese Medical Association wrote a consensus and controversies on the radiotherapy for esophageal carcinoma (draft) after years of research and discussion. We hope it be tried out and discussed with advice and valuable suggestions, in order to accelerate the process of standardization of esophageal carcinoma treatment in China.

Literature analysis of radiotherapy for esophageal cancer in China

Background and Objective: Many patterns of treatment have been used to treat esophageal carcinoma in the past years, however, an optimal treatment is still the key issue to be explored. Therefore, we analyzed the published literature about radiotherapy for esophageal cancer in recent 15 years in China, and observed the survival rate, local control rate, adverse events, and so on. Methods: A total of 56 eligible papers about radiotherapy for esophageal squamous cell carcinoma published in Chinese core periodicals between 1994 and 2009 were selected. The survival rates, local control rates, and adverse events were analyzed. Results: The 1-, 2-, 3-, and 5-year overall survival rates of the patients reported in the 56 papers were (67.99 ± 12.55)%, (49.59 ± 11.79)%, (34.50 ± 11.49)%, and (23.31 ± 10.21)%, respectively. The 1-, 2-, 3-, and 5-year local control rates were (73.04 ± 13.37)%, (61.60 ± 15.50)%, (51.77 ± 15.00)%, and (50.15 ± 21.36)%, respectively. The acute esophageal toxicity rate was (44.84 ± 25.71)% in 32 papers reported in recent 15 years, and the acute esophageal toxicity over grade II accounted for (35.93 ± 22.90)%. The rates of acute esophageal toxicity were (26.84 ± 13.12)% for conventional radiation, (53.72 ± 21.82)% for late course accelerated hyperfractionation radiation, (61.33 ± 28.69)% for concurrent chemoradiotherapy, and (40.31 ± 27.22)% for other ways of radiation. The late toxicity rate described in 23 papers was (5.13 ± 4.07)% in recent 15 years. The late toxicity rates were (5.66 ± 3.42)% for conventional radiation, (4.53 ± 4.07)% for late course accelerated hyperfractionation radiation, (2.24 ±1.31)% for concurrent chemoradiotherapy, and (7.34 ± 5.06)% for other ways of radiation. The Meta analysis indicated that concurrent chemoradiotherapy was better than late course accelerated hyperfractionation radiation and conventional radiation. Conclusions: The long-term survival of patients with esophageal cancer is still disappointed in recent years. Concurrent chemoradiotherapy shows advantages in treating esophageal cancer and, currently, is the best non-surgical treatment of esophageal cancer.

Effect of neoadjuvant chemoradiotherapy on prognosis and surgery for esophageal carcinoma

AIM:To investigate the role of neoadjuvant chemoradiotherapy in prognosis and surgery for esophageal carcinoma by a meta-analysis.METHODS:PubMed and manual searches were done to identify all published randomized controlled trials(RCTs) that compared neoadjuvant chemoradiotherapy plus surgery(CRTS) with surgery alone(S) for esophageal cancer.According to the test of heterogeneity,a fi xed-effect model or a random effect model was used and the odds ratio(OR) was the principal measure of effects.RESULTS:Fourteen RCTs that included 1737 patients were selected with quality assessment ranging from A to C(Cochrane Reviewers' Handbook 4.2.2).OR(95% CI,P value),expressed as CRTS vs S(values>1 favor CRTS arm),was 1.19(0.94-1.48,P=0.28) for 1-year survival,1.33(1.07-1.65,P=0.69) for 2-year survival,1.76(1.42-2.19,P=0.11) for 3-year survival,1.41(1.06-1.87,P=0.11) for 4-year survival,1.64(1.28-2.12,P=0.40) for 5-year survival,0.82(0.39-1.73,P<0.0001) for rate of resection,1.53(1.33-2.84,P=0.007) for rate of complete resection,1.78(1.14-2.78,P=0.79) for operative mortality,1.12(0.89-2.48,P=0.503) for all treatment mortality,1.33(0.94-1.88,P=0.04) for the rate of adverse treatment,1.38(1.23-1.63,P=0.0002) for local-regional cancer recurrence,1.28(0.85-1.58,P=0.60) for distant cancer recurrence,and 1.27(0.86-1.65,P=0.19) for all cancer recurrence.A complete pathological response to chemoradiotherapy occurred in 10%-45.5% of patients.The 5-year survival benefi t was most pronounced when chemotherapy and radiotherapy were given concurrently(OR:1.45,95% CI:1.26-1.79,P=0.015) instead of sequentially(OR:0.85,95% CI:0.64-1.35,P=0.26).CONCLUSION:Compared with surgery alone,neoadjuvant chemoradiotherapy can improve the long-term survival and reduce local-regional cancer recurrence.Concurrent administration of neoadjuvant chemoradiotherapy was superior to sequential chemoradiotherapy.

Meta-analysis of late course accelerated hyperfractionated radiotherapy combined with FP chemotherapy for esophageal carcinoma

Background and Objective:Although there are many randomized clinical trials of late course accelerated hyperfractionated radiotherapy (LCAHFR) combined with FP chemotherapy for esophageal cancer, the efficacy and toxicity are controversial. This study was to evaluate the efficacy and toxicity of LCAHFR combined with FP chemotherapy in treating esophageal cancer. Methods: Reports of randomized clinical trials on LCAHFR combined with FP chemotherapy for esophageal cancer published between January 1999 and January 2009 were researched through Wanfang, CNKI, and PubMed databases. RevMan4.2 software was used for Meta-analysis. Results: Twenty-one reports, including 2030 patients, were included in the meta-analysis. Of the 2030 patients, 1006 underwent LCAHFR (LCAHFR group), and 1024 underwent LCAHFR combined with FP chemotherapy (combination group). Compared with those of the LCAHFR group, the 1-, 2-, 3-, 5-years survival rates and 1-, 2-, 3-year local control rates of the combination group were significant increased, and the acute toxicity was also increased, but chronic toxicity showed no significant difference. C onclusions: LCAHFR combined with FP chemotherapy can improve the survival rate and the local control rate of the patients with esophageal cancer. The increased acute toxicity need to be concerned, whereas the chronic toxicity needs a long-term observation.

Late course three-dimensional conformal radiotherapy for esophageal carcinoma

我们的学习的目的是近来评估临床的结果和尖锐副作用的目的路线为食道的癌的三维的保角的放射疗法(3DCRT ) 。从 2004 年 1 月的方法到 2006 年 10 月，有食道的癌的 70 个病人收到了迟了的功课 3DCRT。他们的临床的数据回顾地被分析。短期的临床的结果，尖锐副作用，本地控制率和幸存率被评估。结果完全的反应率是 62.9% ，部分反应率是 35.7% ，并且全面反应率是 98.6% 。1- ， 2 年、 3 年的本地控制率分别地是 77.1% ， 51.4% 和 45.7% 。1- ， 2 年、 3 年的全面幸存率分别地是 75.7% ， 54.3% 和 38.6% 。中部的幸存时间是 26 个月。结论这种技术近来功课 3DCRT 是为食道的癌的有效治疗并且趋于改进全面幸存率。

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

学习的目的是评估整个功课的三维的保角的放射疗法(3DCRT ) 的治疗学的效果和安全的目的与食道的癌在病人上与迟了功课的加速的 hyperfractionated 放射疗法(LCAFR ) 结合了。有食道的癌的 101 个病人被划分成二个组的方法。观察组(49 个盒子) 被整个功课的 3DCRT 对待。在控制组(52 个盒子) 的病人被常规放射疗法对待。临床的效率和放射毒性在二个组之间被比较。结果包括放射食道炎(63.2%) 和气管炎(49.0%) 的副作用在观察组减少了，但是二个组之间没有重要差别(69.2% 和 55.7% 在控制) 。在观察的组的1-，2年、3年的肿瘤本地人控制率和全面幸存率显著地与控制组相比被改进，分别地87.8%，75.5%，63.3%对71.2%，55.8%，42.3%和85.7%，71.4%，46.7%对69.2%，51.9%，26.9%(所有 P < 0.05 )。整个功课的 3DCRT 的治疗学的效果为食道的癌与 LCAFR 相结合的结论比常规放射疗法优异。

THE DIAGNOSIS AND TREATMENT FOR RECURRENT DYSPHAGIA OF ESOPHAGEAL CARCINOMA AFTER RADICAL RADIOTHERAPY

Objective: To investigate the diagnosis and treatment for recurrent dysphagia of esophageal carcinoma after radical radiotherapy. Methods: The experince of 41 cases with recurrent dysphagia of esophageal carcinoma after radical radiotherapy were retrospectively summerized. Results: All of the cases were surgically treated form July, 1989 to May, 1997 with resectability rate in 97%, operative mortality in 4.8%, postoperative morbidity in 29%. Pathological examination showed squemous cell carcinoma in 82.8%, and serious radiation reaction in 13.2% after operation. The 1, 3, 5year survival rates after operation were 72.7%, 36.3%, 18.1% respectively, and those after radiation in 100%, 60%, and 35.5% respectively. Conclusion: Most of recurrent dysphagia for these cases were due to uncontrolled/recurrent cancer, and minority of them were due to constriction after radiotherapy. It is difficult to distinguish cancer with benigh constriction before operation. Some cases have lymphatic metastasis without local cancer recurrence. For those patients with recurrent disphagia should be treated with operation as early as possible.

Intensify standardized therapy for esophageal and stomach cancer in tumor hospitals

INTRODUCTIONCancer treatment situation in tumor hospitals inChina has its own unique characteristics which arenot found in other parts of the world. Because ofthe huge population and high incidence rates ofesophageal and stomach cancer[1-5], the number ofcancer patients waiting for admission isinconceivably large.

Metastases of esophageal carcinoma to skeletal muscle:Single center experience

Metastases of esophageal carcinoma to the skeletal muscle are rare,but the incidence may be increasing because of better diagnosis resulting from widespread use of positron emission tomography/computed tomography(PET/CT).A cohort of 205 patients with esophageal carcinoma treated at our center who had PET/CT between 2006 and 2010 was retrospectively evaluated for the presence of skeletal muscle metastases.Four patients had skeletal muscle metastases of esophageal carcinoma,including two patients with squamous cell carcinoma.In another patient with squamous cell carcinoma of the esophagus and synchronous skeletal muscle metastases,muscle metastases were subsequently shown to be related to second primary pancreatic adenocarcinoma.In all cases,skeletal muscle metastases were the first manifestation of systemic disease.In three patients palliation was obtained with the combination of external beam radiation therapy,systemic chemotherapy or surgical resection.Skeletal muscle metastases are a rare complication of esophageal carcinoma.

Radioenhancing effect of earthworm capsule medication on radiotherapy in the treatment of patients with carcinoma of esophagus or lung

Earthworm capsule is an extract from earthworm made in our laboratory.From1986 to 1989,486 patients with carcinoma of esophagus or lung were randomly divided into 2groups,one group received radiotherapy alone(control group)and the other radiotherapycombined with earthworm capsules(treatment group).All cases were diagnosedpathologically or cytologically.In a two-month treatment course,earthworm capsuleswere given orally twice a day,2～3 capsules each time,each capsule containing 60 mg ofthe extract.Compared with the control group,the CR(complete remission)rate andCR+PR(partial remission)rate in patients with carcinoma of esophagus treated byradiotherapy in combination with earthworm capsule increased 9.7%(P【0.01) and 9.6%(P【0.05),while in patients with carcinoma of lung,they increased 10.6%(P【0.05)and13.5%(P【0.05),respectively.The earthworm capsule caused irritation in the alimentarytract,the patients displaying slight nausea and vomiting(16.7% in thecombination treatment group and 10.0% in the control group).However,these side ef-fects could be alleviated when capsules were taken after meal or with honey concomitantly.No deleterious effects on the heart,liver,kidney,skin,hematopoietic or nervous systemwere seen.

A CLINICAL STUDY ONINTRALUMINAL HYPERTHERMIA COMBINED WITH EXTERNAL IRRADIATION FOR ESOPHAGEAL CARCINOMA

A randomized trial of intracavitary microwave hyperthermia combined with external irradiation (R+H) versus radiation (R) alone in the treatment of esophageal cancer was performed form February 1986 to February 1988. In the R group, radiation was given by 8 MV X-ray with 2 Gy/fraction, 5 fractions per week with a total dose of 60 Gy/6 weeks. In the R+H group, the radiation was given as R group but with a total dose of 40 Gy/4 weeks. Intracavitary 915 Mhz microwave hyperthermia was given with a nominal temperature of 43.5℃ at the margin of the tumor surface, 45 minutes/session, 1-2 sessions/week for 4-8 session. The 1-, 3-, and 5-year survival rates in R+H group were 81.2% (48/59 cases), 42.4% (25/59) and 23.7% (14/59), while in the R group 59.0% (39/66 cases), 24.2% (16/66) and 16.7% (11/66) respectively. The differences in 1- and 3-year survival rates were statistically significant (P<0.05) between the 2 groups. Using the thermal dose T90 analysis, after the cases with T90<43℃ (insufficient thermal dose) were eliminated, 52 cases with T90 equal to or higher than 43 ℃ had 1, 3, and 5 year survival rates of 84.6%, 44.2% and 26.9%, respectively. Statistically significant differences in the 2 groups were also limited only to 1- and 3-year survivals. Higher 5-year survivals is anticipated if more cases are studied.

六神丸联合放疗治疗食管癌的临床研究及对食管癌炎性微环境与抑制血管生成的影响

目的探究分析六神丸联合放疗治疗食管癌的临床疗效及对食管癌炎性微环境与血管生成的作用机制。方法选取自2020年4月-2022年6月期间就诊并接受治疗的65例食管癌患者为观察对象,将其用随机数字表法分为两组(对照组:32例,观察组:33例)。观察组采取六神丸联合放疗,对照组单纯实施放疗,比较两组患者的临床疗效、治疗前后相关炎性因子水平以及血管内皮生长因子(vascular endothelial growth factor,VEGF)和微血管密度(micro-vascular density,MVD)。结果观察组的治疗总有效率高于对照组(75.76%vs 50%),差异有统计学意义(χ^(2)=4.628,P<0.05);两组患者治疗后,炎性微环境均所有改善,血清C-反应蛋白(C-reactive protein,CRP)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)以及白细胞介素-1β(interleukin-1β,IL-1β)等相关炎性因子指标水平均有所降低,且观察组的改善情况优于对照组,且差异有统计学意义(t=9.276、5.798、4.843,P<0.05);观察组治疗后,其VEGF表达和MVD值都低于对照组,且差异有统计学意义(t=7.169、5.668,P<0.05)。结论六神丸联合放疗治疗食管癌的临床疗效较好,对于食管癌炎性微环境与血管生成的影响较明显,应用价值较高。

不可手术食管癌患者序贯加量IMRT与同步推量IMRT的剂量学比较分析

目的对比不可手术食管癌序贯加量调强放射治疗(SB-IMRT)计划与同步推量调强放射治疗(SIB-IMRT)计划在靶区参数上的区别,以及对正常器官的影响程度。方法选择日照市人民医院2018年10月至2022年5月拟行放射治疗的不可手术食管癌患者30例,其中男性25例,女性5例;年龄60~88岁,中位年龄68.2岁;病变长度4.0~17.6 cm,平均病变长度6.37 cm(标准差2.76 cm);临床分期为c Tx N1-2M0-1期。分别制定SB-IMRT与SIB-IMRT两种放射治疗计划,并采用靶区勾画、射束设野、靶区覆盖、剂量均匀性、危及器官(OAR)、处方剂量(CB-CHOP)审核通过放射治疗计划。SIB-IMRT给予剂量方法为在一个计划中临床计划靶区(PCTV)50.4 Gy,肿瘤计划靶区(PGTV)剂量同步给予59.92 Gy,共28次完成。SB-IMRT剂量要求为PCTV 50 Gy,均分25次完成;完成后修改照射野局部加照至10 Gy,均分5次完成。SB-IMRT放射治疗需设计前后两套计划,再做计划叠加处理,合成一套计划后根据处方剂量要求优化计划并记录靶区参数和OAR限量。采用均匀性指数(HI)、适形性指数(CI)、靶区覆盖度(TC)及剂量分布、OAR限量等参数分别评估。结果两组计划的PCTV-Dmax、PGTV-Dmax和PCTV-Dmin剂量差异无统计学意义(均P>0.05),但SIB-IMRT组PCTV-Dmean、PGTV-Dmin、PGTV-Dmean均低于SB-IMRT组,差异有统计学意义[(57.38±1.73)Gy vs(58.13±2.38)Gy、(51.41±4.90)Gy vs(54.76±6.31)Gy、(61.22±2.10)Gy vs(62.86±2.03)Gy。P>0.05]。两组计划的PCTV-TC值比较,差异无统计学意义(P>0.05)。SB-IMRT组CI优于SIB-IMRT组,而HI次于SB-IMRT组,两组间CI、HI值比较,差异有统计学意义(0.55±0.10 vs 0.60±0.11、1.20±0.38 vs 1.24±0.39。P<0.05)。SIB-IMRT组PGTV和PCTV的生物效应剂量(BED)分别为72.74 Gy、59.47 Gy;SB-IMRT组PGTV和PCTV的BED分别为72 Gy、60 Gy。SIB-IMRT组脊髓Dmax、双肺V5和心脏的平均心脏剂量(MHD)低于SB-IMRT组,差异均有统计学意义[(41.83±2.48)Gy vs(43.27±1.99)Gy、(41.06±11.74)Gy vs(42.26±11.52)Gy、(20.77±8.81)Gy vs(22.72±9.23)Gy。P<0.05]。双肺V_(10)、V_(20)、V_(30)、平均肺剂量(MLD)和心脏V_(30)、V40两组间比较,差异无统计学意义(P>0.05)。结论在不可手术食管癌放射治疗中,相似或/和相等处方剂量的SB-IMRT计划和SIB-IMRT计划,前者仅CI略占优势,后者计划一次成型,能同时给予肿瘤靶区和临床预防靶区不同梯度的剂量照射,具有高效、精确,生物效应高、OAR受照剂量更低的优势,值得临床推广。

基于结构方程模型的潮汕地区食管癌放疗患者营养知信行影响因素研究

目的 探讨潮汕地区食管癌放疗患者营养知信行影响因素,为进一步制订区域化营养护理实践方案提供理论依据。方法 采用便利抽样法选取潮汕地区271名食管癌放疗患者及其271名主要家庭照顾者共计542人作为研究对象。采用问卷或量表调查患者的一般资料、营养状况、营养知信行、癌症自我管理效能感、社会支持;调查照顾者的一般资料、营养知信行、照顾负担、社会支持。应用AMOS 22.0建立潮汕地区食管癌放疗患者营养知信行影响因素结构方程模型,分析各影响因子间的作用机制。结果 潮汕地区食管癌放疗患者营养知信行处于较差水平,及格率仅为7.01%;营养不良发生率100%。构建的营养知信行影响因素结构方程模型拟合良好,结果显示,社会支持、癌症自我管理效能感、经济支持、营养状况、照顾者营养知信行、照顾者主观支持和照顾负担是潮汕地区食管癌放疗患者营养知信行的重要影响因素。结论 潮汕地区食管癌放疗患者营养知信行水平亟待提升,受多种因素影响且作用机制复杂,应动态精准评估,加强针对性干预,促进精准营养。同时患者营养不良严重,需要引起医护人员对区域化肿瘤营养规范化治疗的重视。

食管癌微创术后治疗失败模式及辅助治疗价值评估

我国当前对食管癌术后放疗的推荐主要基于左胸径路不完全两野清扫研究数据,而食管癌外科正处于术式变革期,已逐步由左开胸向右开胸过渡,由开放手术向微创手术(MIE)过渡。当前外科MIE选择适应证人群仍以偏早期患者为主,相较于开放手术,MIE具有更低的创伤性,同时右胸入路也利于更彻底清扫淋巴结,但目前关于食管癌MIE后肿瘤治疗失败模式数据及相关研究较少,很难指导后续治疗,MIE后对于选择性高危患者是否仍需辅助治疗及优选治疗模式仍有待临床探索。基于此背景,本文拟对MIE的安全性及患者长期生存结果、术后复发模式及失败率等问题进行综述,从而探讨术后辅助治疗价值并指导临床治疗。

胸上段食管癌调强放疗与适形放疗计划的剂量学比较

背景与目的:胸上段食管癌所处的解剖特点导致其放疗计划的制订难度很大,而调强放疗(intensity-modulated radiotherapy,IMRT)有可能克服上述难题。本研究比较分析IMRT和三维适形放疗(conformal radiotherapy,CRT)在胸上段食管癌的剂量学优劣,为IMRT在食管癌的临床应用提供参考。方法:选择胸上段食管癌11例进行研究。在实际治疗采用的CRT计划基础上,每一病例再设计一5野IMRT计划进行对比。对比内容包括相关靶区和危及器官的剂量体积直方图参数。结果:肿瘤及相邻组织的计划靶区可见IMRT和CRT计划之间的平均剂量、最大剂量、包含99%和95%靶区的剂量均很接近(P>0.05),但IMRT较CRT的适形指数好(0.68±0.04vs.0.46±0.11,P<0.01)。IMRT对锁骨上区的剂量均匀性较CRT更好,二者的非均匀指数分别为1.17±0.05和1.33±0.15(P=0.01)。IMRT计划中脊髓计划区的最高受量明显较CRT的低(44.4Gy vs.52.5Gy,P<0.05);10Gy以上的肺受照体积为(32±6)%,也明显较CRT计划的(35±9)%低(P<0.05)。结论:对胸上段食管癌,调强放疗较适形放疗有更好的剂量适形性,可更有效保护脊髓,并显著降低肺10Gy以上剂量的受照体积。