后程加速超分割三维适形放疗食管癌的远期疗效和预后分析  

Late-course accelerated hyperfractionated three-dimensional conformal radiotherapy for esophageal carcinoma with long-term result and prognostic analysis

作　　者：任宝志[1] 韩磊[1] 朱培军[1] 山长平[1] 孔凡华[1] 

机构地区：[1]山东济宁医学院附属医院肿瘤科

出　　处：《中华放射肿瘤学杂志》2006年第2期93-96,共4页Chinese Journal of Radiation Oncology

摘　　要：目的 对比研究后程加速超分割三维适形放疗食管癌的远期疗效、副反应及失败原因。方法 将150例食管鳞癌患者用信封法随机均分至后程加速超分割三维适形放疗组（后超组）和后程常规分割三维适形放疗组（对照组）。放疗方法均为前2／3疗程普通模拟机定位常规放疗40Gy，后1／3疗程后超组改为CT模拟定位加速超分割三维适形放疗（1．5Gy／次，2次／d，18～27Gy），总剂量为58～67Gy，32～38次，全疗程36～39d；对照组常规分割三维适形放疗至上述相当剂量。结果 后超组和对照组5年生存率分别为33％和15％，后超组生存率高于对照组（P=0。029）。后超组中位复发时间也高于对照组（11．0、7．0个月，P〈0．01）。3、4、5年无瘤生存率分别为35％、33％、32％和20％、17％、17％，后超组无瘤生存率均高于对照组（P值均〈0．05）。后超组和对照组1、2、3、4、5年局部控制率分别为79％、73％、63％、61％、61％和60％、39％、31％、29％、27％，后超组局部控制率均高于对照组（P值均〈0．05）。Cox回归分析显示颈段、胸上段食管癌的疗效明显优于胸中段、胸下段食管癌，蕈伞型优于其他类型（P值均〈0．01）。结论 常规放疗后进行后程加速超分割三维适形放疗可作为颈段、胸上段和蕈伞型食管癌的首选方法之一，它提高了局部控制率和远期生存率。Objective To analyze the remote results of esophageal carcinoma patients treated with latecourse accelerated hyperfractionated three-dimensional conformal radiotherapy（IEAF3DCRT）. Methods 150 esophageal carcinoma patients were divided randomly into two 6oups： 1. LCAF3DCRT 6oup---75 patients were treated by conventional fractionated radiotherapy during the first two-thirds of the course with 40 Gy/20 fractions/ 4 weeks, then followed by hyperfraction 3DCRT with 18-27 Gy over 12-18 days, 1.5 Gy per fraction, to a total dose of 58-67 Gy in 32-38 fractions over 36-39 days; and 2. Control group--75 patients were treated with the same method during the two-thirds, but followed by conventional fractionated 3DCRT with the same dose. Results The 5-year survival rate was 33% and 15% in LCAF3DCRT and control group, respectively（ P =0.029）. The median relapse time was 11.0 and 7.0 months in LCAF3DCRT and control group, respectively（ P 〈 0.01 ）. The 3-, 4-, and 5-year tumor-free survival rate was 35 %, 33 %, 32 % and 20 %, 17 %, 17 % in LCAF3DCRT and control group, respectively（all P 〈 0.05）. The 1-, 2-, 3-, 4-, and 5-year local control rate was 79 %, 73 %, 63 %, 61% ,61% and 60% ,39% ,31% ,29% ,27% in LCAF3DCRT and control group, respectively（all P 〈 0.05）. Cox multivariate model indicated that the effectiveness was superior to others if the tumor was located either in the cervical or upper segment, or was the fungating type（ P 〈 0.01）. Conclusion Late-course accelerated hyperfractionated three-dimensional conformal radiotherapy can be taken as the first choice for esophageal carcinoma in the cervical or upper segment, or the ftmgating type after conventional fractionated radiotherapy. It can improve the local control and survival rate.

关 键 词：食管肿瘤/放射疗法 放射疗法 适形 预后 

分 类 号：R735.1[医药卫生—肿瘤] R730.55[医药卫生—临床医学]