食管癌不同定位方式放疗协同化疗的疗效和预后分析  

Long-term result and prognostic analysis of radiotherapy in different ways and concurrent chemotherapy for esophageal carcinoma

作　　者：任宝志[1] 周玉霞[1] 张红[1] 幸泽鲜[1] 陶星[2] 

机构地区：[1]德阳市人民医院肿瘤科,四川德阳618000 [2]上海交通大学医学院苏州九龙医院核医学科PET/CT室,江苏苏州215021

出　　处：《现代肿瘤医学》2016年第3期417-421,共5页Journal of Modern Oncology

摘　　要：目的:比较各期食管癌普通X线模拟定位、CT定位以及PET/CT定位三维适形放疗(3DCRT)协同化疗的疗效、毒副反应和预后。方法:回顾性分析10年间各期食管癌共546例,分别接受普通X线模拟定位(普放组)、CT定位(适形组)和PET/CT定位(PET/CT组)放疗;协同化疗以铂类为基础联合氟尿嘧啶类或紫杉醇类等化疗4~6个周期(21~28d为1个周期)。随访并比较各种治疗方法的疗效、毒副反应和预后。结果:PET/CT组的平均大体肿瘤体积(GTV)与计划靶区(PTV)体积均比普通CT组小[(2.8±1.4)cm^3、(9.2±2.7)cm^3]。适形组的咽和食管、肺和气管的1-2级早期放射反应均高于PET/CT组(P均<0.05)。PET/CT组的1、2、3年局部控制率和1、2、3、4、5生存率均高于普放组与适形组差异具有显著统计学意义(P均<0.01)。普放组死于原发灶未控、复发以及放射性肺炎的比例高(P均<0.05)。病变位于胸上段、髓质型和蕈伞型、病变长度≤5cm、无淋巴结转移、T早分期病变预后较好。结论:CT定位与PET/CT定位三维适形放疗可提高局部控制率、降低毒副反应,以PET/CT定位为最优。Objective：To analyse the result and prognosis of radiotherapy by ordinary X-based simulation,T simulation,ET/CT positioning three-dimensional conformal radiotherapy（3DCRT） and concurrent chemotherapy for esophageal carcinoma.Methods：To review 546 patients with esophageal carcinoma by ordinary X ray simulator（normal group）,CT localization（CRT group） and PET/CT localization（PET/CT group） radiotherapy.All cases were treated by platinum-based joint-paclitaxel or fluorouracil to 4～6 cycles of concurrent chemotherapy（21～28d 1 cycle）.Follow-up and compare the efficacy of various treatments,side effects and prognosis.Results：The average volume of GTV and PTV of the PET/CT group was smaller than that of the CT group （2.8±1.4）cm^ and （9.2±2.7）cm^3.The early 1-2 grade radiation reaction of the CT group of pharynx and esophagus,lung and trachea was higher than that of the PET/CT group（all P〈0.05）.The 1,2,3-year local control rates and 1,2,3,4,5-year survival rates of the PET/CT group were higher than that of the normal group and the CT group（all P〈0.01）.Cases died of uncontrolled primary tumor,recurrence and radiation pneumonitis of the normal group were higher than that of others（all P〈0.05）.Multivariate analysis showed that the lesion located in the upper chest,medullary and mushroom umbrella type,esion length ≤5cm,no lymph node metastasis and early T stage were better than that of others（all P〈0.01）.Conclusion：Using PET/CT to determine the target of esophageal carcinoma can improve the radiation treatment plan,reduce the recurrence rate of hilar and mediastinal.ET/CT positioning three-dimensional conformal radiotherapy has the best effect.

关 键 词：食管肿瘤 放射疗法 化学疗法 三维适形放疗 体层摄影术 正电子发射型 预后 

分 类 号：R735.1[医药卫生—肿瘤]