28例颈、胸上中段食管鳞癌同期加量调强放疗的近期疗效及毒副反应  

The Short-Term Effect and Toxicity of Simutaneous Boost Intensity-Modulated Radiotherapy for 28 Patients with Cervical or Thoracic Upper or Middle Esophageal Sequamous Cell Carcinoma

作　　者：裘国勤[1] 杜向慧[1] 郑远达[1] 罗浩杰[1] 许亚萍[1] 陈建祥[1] 孙晓江[1] 季永领[1] 

机构地区：[1]浙江省肿瘤医院,浙江杭州310022

出　　处：《肿瘤学杂志》2010年第1期30-34,共5页Journal of Chinese Oncology

摘　　要：[目的]评价颈、胸上中段食管鳞癌同期加量调强放疗合并化疗的近期疗效及毒副反应。[方法]28例T1～4N0～1M0期颈、胸上中段食管鳞癌行预防性次全淋巴放疗,PGTV(包括原发肿瘤和转移淋巴结)和PTV(包括预防性次全淋巴照射区)予同期加量调强放疗(SIB-IMRT),PTV-GTV处方剂量66Gy/30f,PTV-CTV处方剂量60Gy/30f。放疗期间及放疗前后PF或TP方案化疗4个周期。[结果]28例患者按计划完成了全量放疗,21例患者接受2个周期以上化疗,15例患者接受1～2个周期同步化疗。CR28.6%(8/28),PR50%(14/28)。中位随访8.5个月(2～17个月),5例死亡。局部未控或复发率35.7%(10/28),无一例出现野内淋巴结进展或复发。远处转移率10.7%(3/28),其中1例贲门周围淋巴结转移。7例治疗后体重下降超过5%。无2度以上心脏、肝脏、肾脏毒性;无3度以上急性肺损伤;3～4度食管炎5例,均接受了同期化放疗;3～4度血液学毒性3例;2例食管瘘形成;无治疗相关死亡。[结论]颈、胸上中段食管鳞癌同期加量调强放疗合并化疗是可以耐受的,可降低区域淋巴结复发,野外淋巴结复发少见,但局部复发仍是主要失败形式。[Purpose] To assess short-term effect and toxicity of simutaneous boost intensity-modulated radiotherapy （SIB-IMRT） combined with chemotherapy for cervical or thoracic upper or middle esophageal sequamous cell carcinoma. [Mehhodsl Twenty-eight cases with stage T1-4N0-1M0 esophageal sequamous cell carcinoma underwent prophylactic subtotal lymphatic irradiation. PGTV including primary tumor and metastatic lymph nodes and PTV including prophylactic subtotal lymphatic irradiated region were treated with SIB-IMRT. The prescribed dose for PTV-GTV with 66Gy/30f and 60Gy/30f for PTV-CTV and 4 courses of PF- or TP-based chemotherapy were administered during and before （or after）radiotherapy. [Results] Twenty-eight patients completed full dose of planned radiotherapy and 21 received more than two courses of chemotherapy, 15 received one or two courses of concomitant chemotherapy. Complete response rate was 28.6%（8/28）; partial response rate, 50%（14/28）; and death, 5 cases. The median follow-up was 8.5 months （2-17 months）. Local persistent disease or recurrence was 35.7% （10/28）. Recurrence in radiation region was not found. Distant metastasis rate was 10.7% （3/28）. Pericardial lymph node metastasis was found in 1 case. Loss weight more than 5% was found in 7 cases. No toxicity 〉grade 2 for heart, liver and kidney, no toxicity 〉grade 3 for lung, 5 cases with grade 3-4 esophagitis, 3 cases with grade 3-4 hematologic toxicity and 2 cases with esophageal fistula were found. Treatment-related death was not found. [ Conclusions ] Simutaneous boost intensity-modulated radiotherapy for cervical or thoracic upper or middle esophageal carcinoma is tolerable and can decrease regional recurrence. Lymphatic metastases out of the field is rarely seen. Local recurrence are still the dominant patterns of failure.

关 键 词：食管肿瘤 放射疗法 调强适形 药物疗法 同步治疗 近期疗效 毒副反应 

分 类 号：R735.1[医药卫生—肿瘤]