食管癌放疗后复发再程三维适形放疗同步化疗的临床观察  

Three dimensional conformal radiotherapy concurrent with chemotherapy in recurrence from esophageal carcinoma after radiotherapy

作　　者：罗宏涛[1] 魏世鸿[1] 王小虎[1] 张秋宁[1] 刘瑞峰[1] 

机构地区：[1]甘肃省肿瘤医院放疗科,甘肃兰州730050

出　　处：《中华肿瘤防治杂志》2013年第5期371-373,共3页Chinese Journal of Cancer Prevention and Treatment

基　　金：甘肃省科技厅创新团队资助项目(098TTCA009)

摘　　要：目的:探讨食管癌放疗后复发再程放化疗的价值。方法:48例食管癌放疗后复发患者接受再程治疗。随机分成单纯放疗组(25例)和放化综合治疗组(23例),再程放疗采用三维适形精确放疗技术,6MV X射线,4～5个共面或非共面适形照射野,2.0Gy/次,总剂量46～56Gy。化疗采用多西紫杉醇60～75mg/m2,加入5%GS 250mL静脉滴入,d1;顺铂20mg/m2,加入NS 250mL中静脉滴入,d1～d3;21d为1个周期。结果:单纯放疗组与放化综合治疗组近期局控率分别为80.0%(20/25)和82.6%(19/23),差异无统计学意义,χ2=1.23,P=0.281;单放组1、2和3年生存率分别为52.0%、28.0%和8.0%;放化综合治疗组为56.5%、47.8%和21.7%;差异无统计学意义,χ2=0.89,P=0.269。放化综合组放射性食管炎、放射性肺损伤及Ⅰ～Ⅲ级骨髓抑制发生率分别为47.8%(11/23)、34.8%(8/23)和52.2%(12/23),明显高于单纯放疗组16.0%(4/25)、8.0%(2/25)、16.0%(4/25),差异有统计学意义,χ2值分别为5.65、5.21和7.05,P值分别为0.029、0.033和0.013;死因分析结果显示,单纯放疗组以局部未控(60.0%,15/25)及远处转移(64.0%,16/25)为主,而放化综合组治疗毒副作用导致死亡率明显升高(43.5%,10/23)。结论:三维适形精确放射治疗联合TP方案化疗可作为食管癌放疗后复发患者的有效治疗手段,但应谨慎选择患者。OBJECTIVE：To explore the value of three dimensional conformal radiotherapy concurrent with chemotherapy for recurrence from esophageal carcinoma after radiotherapy. METHODS：Totally 48 cases were divided randomly into radiotherapy group （25 cases） and chemoradiotherapy group （23 cases）. Three-dimensional conformal radiotherapy was used with 6 MV X line,4 or 5 co- planar or non-coplanar conformal radiation field,2.0 Gy/time, total dose 46--56 Gy; TP regimen was used for chemotherapy group with docetaxel 60-- 75 rag/m2 , d1 ＋ cisplatin 25 mg/m2 ,d1 -- d3, intravenously. RESUL＇IS： The total response rate was 80. 0 % （20/25 ） in radiotherapy group and 82. 6 % （19/23） in chemoradiotherapy group, the difference was not statistically significant （？（2 = 1.23, P= 0. 281 ） ; 1,2,3 year survival rate was 52 %. 0,28. 0 %, 8.0 % in radiotherapy group, while the chemoradiotherapy group was 56. 5 %, ,17. 8 %, 21.7 % respectively, the difference was not statistically significant X2 = 0. 89, P = 0. 269）. The occurrence rate of radiation esophagitis,radiation pneumonitisd and I-HI degree bone marrow suppression were 47. 8M （11/23）,34. 8%（8/23）,52. 2%（12/23） respectively in chemoradiot herapy group, it was significantly higher than that in radiotherapy alone group, which were 16.0 % （4/25）, 8.0% （2/25）,16.0%（4/25）,lhe difference was significant X2 respectively was 5.65,5.21,7. 05,P were 0. 029,0. 033,0. 013）. The cause of death in radiotherapy alone group was local failure （60.0%, 15/25） and distant metastasis （64.0%, 16/25） while it was side effects of treatment in chemoradiotherapy group（43. 5%, 10/23）. CONCLUSION： Chemoradiotherapy can improve survival rates in carefully selected patients who recurred from esophageal carcinoma after radiotherapy.

关 键 词：食管肿瘤 放化疗 生存率 再程 三维适形放疗 

分 类 号：R735.1[医药卫生—肿瘤]