食管癌调强放射治疗初期疗效分析  

Short-term efficacy of intensity-modulated radiotherapy on esophageal carcinoma

作　　者：王军[1] 韩春[1] 李晓宁[1] 高超[1] 贾敬好[1] 蔡博宁[1] 张辛[1] 肖爱勤[1] 

机构地区：[1]河北医科大学第四医院放疗科,河北石家庄050011

出　　处：《癌症》2009年第11期1138-1142,共5页Chinese Journal of Cancer

基　　金：河北省普通高等学校强势特色学科(群)项目(No.200552);河北省医学科学研究重点课题计划(No.08153)~~

摘　　要：背景与目的:食管癌调强放射治疗临床研究国内外报道较为少见,其临床疗效如何,是否会引起较为严重的大范围低剂量照射肺损伤等问题亦无成熟经验。本研究旨在评价调强放疗技术对食管癌的初期疗效及治疗不良反应。方法:2006年6月至2008年3月,采用调强放疗技术治疗37例颈段、胸段食管癌,评价肿瘤反应率、肿瘤局部控制率、生存率和治疗相关不良反应。结果:全组患者100%肿瘤区(gross tumor volume,GTV)、95%临床靶区(clinical target volume,CTV)和95%计划靶区(planning target volume,PTV)接受剂量分别为(6456±172)cGy、(6293±145)cGy和(5988±53)cGy。接受≥5Gy、≥10Gy、≥20Gy、≥30Gy的肺组织占全肺体积的百分比和肺平均剂量分别为(59.6±12.8)%、(39.5±8.7)%、(22.0±5.4)%、(12.0±4.3)%和(1178±248)cGy。肿瘤总反应率为97.3%(36/37)。中位随访时间为13个月(8～29个月),3级及以上急性和晚期放射性食管损伤发生率分别为16.2%和7.2%;2级及以上急性和晚期放射性肺损伤发生率分别10.8%和8.1%。1、2年肿瘤局部控制率分别为72.9%、72.9%;1、2年总生存率分别为80.9%、67.4%;1、2年无瘤生存率分别为73.5%、51.4%。局部未控和复发占总治疗失败的69.2%。结论:食管癌调强放射治疗初期疗效较好,急性和晚期放射性肺损伤发生率较低。治疗失败的主要原因仍为肿瘤局部未控和复发。Background and Objective. Intensity-modulated radiotherapy （IMRT） for esophageal carcinoma has seldom been reported; its clinical efficacy and toxicity are still uncertain. This study was to evaluate the short-term efficacy of IMRT on esophageal carcinoma, and to observe adverse events. Methods. From June 2006 to March 2008, 37 patients with cervical and thoracic esophageal carcinoma were treated with IMRT. The treatment response, local control and survival were evaluated and the adverse events were observed. Results. The minimal prescription dose of 100% of gross tumor volume （GTV D10o） 95% of clinical target volume （CTVD95）, and 95% of planning target volume （PTVD95） were （6 456±172）cGy, （6 293±145）cGy, and （5 988±53）cGy, respectively. The volumes of lung receiving irradiation of ≥ 5 Gy, ≥10 Gy, ≥20 Gy and ≥30 Gy were （59.6±12.8）%, （39.5±8.7）%, （22.0±5.4）%, and （12.0±4.3）%, respectively. The mean lung dose （MLD） was （1 178±248）cGy. The overall response rate was 97.3% （36/37）. The patients were followed-up for 8-29 months （median,13 months）. The occurrence rates of grades 3-4 acute and late esophagitis, grades 2-4 acute and late pneumonitis were 16.2% and 7.2%, 10.8% and 8.1%. The 1- and 2- year local control rates were 72.9% and 72.9%. The 1- and 2-year overall survival rates were 80.9% and 67.4%. The 1- and 2-year disease-free survival rates were 73.5% and 51.4%. Local recurrence （69.2%） was the main reason of treatment failure. Conclusion： IMRT is an effective treatment for esophageal carcinoma with low occurrence of acute and late radiation-related pneumonitis, but local failure is still a main problem for treatment of patients with esophageal carcinoma.

关 键 词：食管肿瘤 调强放射治疗 预后 疗效 

分 类 号：R735.1[医药卫生—肿瘤]