食管癌外照射加腔内放射治疗的临床分析  

The Role of High-dose-rate Brachytherapy (HDR-BT) in the Radiotherapy of Esophageal Carcinoma

作　　者：杜芳芳[1] 赵路军[1] 袁智勇[1] 王军[1] 庞青松[1] 李瑞英[1] 刘玉忠[1] 王平[1] 

机构地区：[1]天津市肿瘤防治重点实验室,天津医科大学附属肿瘤医院放疗科,天津市300060

出　　处：《中国肿瘤临床》2010年第8期471-474,共4页Chinese Journal of Clinical Oncology

摘　　要：目的：分析高剂量率后装腔内放疗在食管癌放射治疗中的应用价值.方法：回顾性分析1999年3月至2005年12月在天津医科大学附属肿瘤医院接受放射治疗的食管癌患者的临床资料.符合条件的患者共89例.其中单纯外照射组62例,外照射联合腔内放疗组（联合照射组）27例,有42例患者接受了序贯或同步化疗.将患者分为单纯外照射组和外照射联合腔内放疗组进行分析,单纯外照射多为前后两野对穿照射40Gy后缩野避开脊髓加量,腔内放疗多在外照射结束后1周内开始,一般4～7Gy/次,每周1次,共2-3次.部分患者接受了化疗,常用化疗方案为顺铂加氟脲嘧啶方案.应用完全缓解率和治疗后进食改善率评价近期疗效,应用无局部复发生存率（LRFS）及总生存率（OS）评价远期疗效.统计分析采用χ^2检验比较两组间有效率及进食改善率的差别,Kaplan-Meier计算两组的OS及LRFS,Log-Rank比较两组间OS及LRFS的差别.结果：全组生存患者中位随访时间34个月,至最后随访之日63例患者死亡.单纯外照射组与联合照射组的完全缓解率分别为10%及29%（P=0.049）;进食改善率分别为67.7%和74.1%（P=0.795）;5年无局部复发生存率分别为24%和36%（P=0.332）;5年总生存率分别为18%和21%（P=0.401）.肿瘤长度≤5cm及〉5cm组联合放疗与单纯放疗的5年生存率分别为42%、36%（P=0.045）及16%、14%（P=0.685）.结论：后装腔内放疗联合外照射可提高近期疗效及较小病灶（肿瘤长度≤5cm）患者的生存率.Objective： To study the role of high-dose-rate brachytherapy （HDR-BT） in the radiotherapy of esophageal cancer. Methods： We reviewed 89 patients with esophageal carcinoma treated with radiation therapy between March 1999 and December 2005 in our hospital. There were 62 patients in the external beam radiotherapy group （EBRT group） and 27 patients in the combination of HDR-BT and EBRT group （combined group）. Forty-two patients received sequential or concurrent chemotherapy. Patients in EBRT group were firstly treated with parallel-opposed antero-posterior field at a total dose of 40Gy, and then off-cord oblique fields were used at a final median total dose of 65Gy （ranged from 40 to 70Gy）. HDR-BT was commonly performed weekly for 2-3 times at a dose fraction of 4-7Gy. Some patients received sequential or concurrent chemotherapy with cisplatin and fiuorouracil. The endpoints were complete release （CR）, improvement of obstruction, local-recurrence free survival （LRFS） and overall survival （OS）. Chi-square test was used for comparison of the difference in CR rate and the improvement in patients＇ food intaking. Kaplan-Meier method was exployed to analyze patient survival and Log-rank test was used to compare the difference in OS and LRFS. Results; The median follow-up period was 34 months. Sixty-three patients died during the follow up. The CR rates of EBRT group and combined group were 10% and 29%, respectively （P=0.049）. The improvement rate in food intaking in the two groups were 67.7% and 74.1%, respectively （P=0.795）. The 5-year LRFS was 24% in EBRT group and 36% in combined group （P=0.332）. The 5-year OS was 18% in EBRT group and 21% in combined group （P=0.401）. The 5-year OS was 42% in patients with tumor smaller than 5cm and 36% in patients with tumor larger than 5cm （P=0.045）. The 5-year OS was 16% in patients treated with brachytherapy and 14% in patients who didn＇t receive brachytherapy （P=0.685）. Conclusion： The combination of HDR-BT and EBRT can

关 键 词：食管肿瘤 放射疗法 近距离放射疗法 

分 类 号：R739.4[医药卫生—肿瘤]