^252Cf中子腔内后装加体外照射治疗食管癌的临床研究  

Cf-252 neutron intracavitary brachytherapy combined with external-beam radiotherapy for esophageal carcinoma

作　　者：陶桂荣 刘增义 张厚才 赵允正 陈喜梅 丁红云 

机构地区：[1]山东潍坊肿瘤医院放疗科,潍坊261061

出　　处：《中华放射肿瘤学杂志》2008年第3期198-201,共4页Chinese Journal of Radiation Oncology

摘　　要：目的比较锎（^252Cf）中子腔内后装加体外照射与单纯体外照射治疗食管癌的疗效、副反应及晚期并发症。方法将86例患者随机均分成^252Cf中子腔内后装加体外照射（腔内组）与单纯体外照射（外照组）组。外照组采用医科达医用直线加速器三维适形或常规体外照射，总剂量DT70Gy分35次7．0周完成。腔内组外照射方式、方法同外照组，但总剂量DT60Gy分30次6.5周完成另加腔内照射。腔内照射方法是经口置特制带水囊的食管施源器于食管病变部位，以距离源10mm处为剂量计算参考点，病变上下两端外放1—2cm；4Cy／次，1次／周，共3—4次。先中子治疗，第2天开始外照射，腔内与外照射同步，腔内治疗之日不进行外照射。结果治疗后进食阻挡改善者腔内组明显早于外照组，腔内组中6例进水困难者经1次食管球囊扩张、^252Cf中子腔内治疗加外照射5—6d即可进流食，2周后进软食。结束后3个月完全缓解率、部分缓解率和无改变率腔内组分别为33％、67％和0％，外照组分别为19％、76％和5％，两组近期有效率分别为100％和95％（Χ^2=4.32，P〈0.05）。腔内组和外照组1年局部控制率分别为84％和70％（Χ^2=4．57，P〈0．05）；1年生存率分别为81％和61％（Χ^2=4．17，P〈0．05）；急性放射性食管炎发生率61％、51％；（Χ^2=1.75，P〉0．05）和晚期食管狭窄发生率5％、7％；（Χ^2=0．35，P〉0.05）相似。结论食管癌采用^252Cf中子腔内后装加体外照射治疗的疗效优于单纯体外照射，且未明显增加放疗副反应。Objective To compare the efficacy, toxicity and later period complications of Cf-252 neutron intracavitary brachytherapy（IBT） combined with external-beam radiotherapy（EBRT） with those of EBRT alone in patients with esophageal carcinoma. Methods Eighty-six patients were randomized into ^252 Cf neutron IBT and EBRT group （intracavitary group： 43 patients） and EBRT alone group（ external group： 43 patients）. The external group was treated with three-dimensional conformal radiotherapy （3DCRT） or conventional radiotherapy of 70 Gy in 7.0 weeks using Elekta Precise medical linear accelerator. The EBRT in intracavitary group was as same as external group, except the total dose was decreased to 60 Gy in 6.5 weeks. For IBT, the applicator with special water bursa was settled to the esophageal lesion through the mouth. The dose calculation point was 10 mm far away from the source and 1-2 cm cranial-caudally from the tumor margin. ^252Cf brachytherapy was delivered 3-4 fractions at 4 Gy per fraction per week. In intracavitary group, EBRT was begun on the second day of IBT. EBRT and IBT were not given on the same day. Results After the treatment, the esophageal stricture was relieved earlier in intracavitary group than external group. Six patients in intracavitary group who had drinking obstruction symptom could eat liquid food after esophageal balloon dilation,one fraction of ^252Cf neutron IBT and 5-6 days of EBRT,and could eat semiliquid food two weeks after. In the third month, the complete response rate, partial response rate and no response rate were 33% ,67% and 0% in intracavitary group and 19% ,76% and 5% in external group,respectively. The overall response rates of the two groups were 100% and 95% （Χ^2 =4.32,P 〈 0.05 ）. The 1-year local control rates were 84% and 70% （ Χ^2 = 4.57 ,P 〈 0.05 ）. The 1 -year survival rates were 81% and 61% （ Χ^2= 4.17, P 〈 0.05 ）. The rates of acute esophageal toxicity was 61% and 51% （ Χ^2= 1.75,P 〉 0.05 ）. The acute radiation esopha

关 键 词：食管肿瘤/放射疗法 食管肿瘤/近距离放射疗法 锎-252 中子 治疗结果 

分 类 号：R686[医药卫生—骨科学]