食管癌后程加速超分割放疗联合同期化疗的临床研究  

Late course accelerated hyperfractionated radiotherapy with concurrent chemotherapy for esophageal carcinoma

作　　者：许明君[1] 王钇力[1] 郭海亮[1] 黄莉[1] 王祥财[1] 

机构地区：[1]赣南医学院第一附属医院肿瘤科,江西赣州341000

出　　处：《实用肿瘤杂志》2013年第4期405-407,共3页Journal of Practical Oncology

摘　　要：目的比较后程加速超分割三维适形放疗和常规分割三维适形放疗联合同期化疗TP(紫杉醇加顺铂)方案治疗食管癌的疗效与不良反应。方法回顾性分析46例初治食管鳞癌患者。其中后程加速超分割三维适形放疗(后超组)和常规分割三维适形放疗(对照组)联合同期化疗TP治疗各23例。后超组:先行放疗DT 41.4 Gy/23次,1.8 Gy/次,每天1次;后程缩野放疗DT 21～27 Gy/14～18次,1.5 Gy/次,每天2次;全疗程40-44天。对照组:2.0 Gy/次,每天1次,先放疗23次,再缩野放疗至DT 60～66 Gy/30～33次,全疗程40-45天。两组均在放疗同期加用2周期TP(紫杉醇联合顺铂)方案化疗。分析两组的1、2年局控率和生存率以及急、慢性不良反应。结果随访9-39月,后超组1、2年局控率分别为65.2%、56.5%,对照组分别为52.2%、39.1%(P>0.05)。后超组1、2年生存率分别为69.6%、34.8%,对照组分别为47.8%、21.7%(P>0.05)。后超组和对照组3、4级急性食管炎发生率为39.1%、8.7%(P<0.05);3、4级急性支气管炎发生率为34.8%、8.7%(P<0.05);Ⅲ～Ⅳ度粒细胞减少为30.4%、26.1%(P>0.05);≥Ⅱ级放射性肺纤维化为13.0%、17.4%(P>0.05)。结论食管癌后程加速超分割放射治疗联合同期TP化疗有提高局部控制率和生存率的趋势,但急性不良反应有所提高,但可耐受。Objective To evaluate the efficacy and toxicity of late course accelerated hyperfractionated （LCAF） threedimensional conformal radiotherapy with concurrent chemotherapy for esophageal carcinoma patients. Methods Forty six patients with esophageal carcinoma underwent late course accelerated three-dimensional conformal radiotherapy with concurrent chemotherapy, including 23 patients receiving hyperfractionated radiotherapy （LCAF ＋ C group ） and 23 receiving conventional fractionated radiotherapy （ control group）. The protocol for LCAFR ＋ C group was first radiotherapy 1.8 Gy/f x 23 （ DT 41.4 Gy） , once per day; then 1.5 Gy/f x （ 14 - 18） （DT 21 ~ 27 Gy） , twice per day; that for control group was 2.0 Gy/f x 23, once per day, the local boost 60 ~ 66 Gy/（ 30 ~ 33 ） f for 40 - 45 d. In the same period both groups received two cycles of TP （ paclitaxel plus cisplatin ） chemotherapy. The main outcome measures included 1, 2-year local control rates and survival rates, the acute toxicities of esophagus and trachea, and lung radiation injury. Results After 9 - 39 months of follow-up the LCAFR ＋ C group showed a trend of better results in 1,2-year local control rates and survival rates compared to control group, but no statistical difference was detected（65.2%, 56.5% vs52.2%, 39.1%; 69.6%, 34.8% vs47.8%, 21.7%; allP〉0.05）. The acute toxicity of the LCAFR＋C was more serious including llI- 1V grade acute esophagitis and bronchitis, compared to control group （ both P 〈 0.05 ）. There was no significant difference in radiation-induced pulmonary fibrosis between two groups （ P 〉 0. 05 ）. Conclusion LCAFR ＋ C treatment has a trend of increased local control and long-term survival and also higher acute toxicity for patients with esophageal carcinoma.

关 键 词：食管肿瘤 放射疗法 放射疗法 适形 食管肿瘤 药物疗法 综合疗法 预后 回顾性研究 随访研究 

分 类 号：R735.1[医药卫生—肿瘤] R730.53[医药卫生—临床医学]