不同剂量放疗治疗食管癌的前瞻性临床研究  

Prospective clinical study of the different radiotherapy dose in the treatment of esophageal cancer

作　　者：徐志渊[1] 林连兴[1] 姚二华 黄建豪[1] 张晓平[1] 颜明明[1] XU Zhi - yuan;LIN Lian - xing;YAO Er - hua;HUANG Jian - hao;ZHANG Xiao - ping;YAN Ming - ruing.(Radiotherapy De- partment of Shantou Central Hospital, Shantou 515031, Guangdong, China)

机构地区：[1]汕头市中心医院放疗科,广东汕头515031

出　　处：《广东医学》2018年第11期1644-1649,共6页Guangdong Medical Journal

基　　金：广东省科技计划项目(编号:2013B021800047)

摘　　要：目的前瞻性比较不同剂量放疗联合同期顺铂化疗根治性治疗不可手术食管癌的疗效及毒性不良反应。方法收集新诊断不能手术的无远处转移食管癌患者60例,采用常规分割三维适形放疗技术,放疗总剂量至少60 Gy。放疗至40 Gy时复查食管造影,肿物消退不明显者提高放疗剂量,在严格限制正常组织放疗剂量的基础上总剂量最高至70 Gy。总剂量≤64 Gy为低剂量组,>64 Gy为高剂量组。同期顺铂化疗,每周1次,最多7次。结果共入组60例患者,放疗结束后2个月有效率:低剂量组为92.1%,高剂量组为100%,差异无统计学意义( X^2=0.544,P=0.461)。中位生存期(m OS):中位随访19个月,低剂量组m OS为27.67个月,高剂量组m OS为16.67个月,差异有统计学意义(P=0.048)。多因素分析显示放疗剂量是总生存的独立预后因素(P=0.043)。与低剂量组相比,高剂量组有增加放射性食管炎的趋势,但是差异无统计学意义(P=0.075)。结论 >64 Gy的高剂量放疗可能增加放射性食管炎的发生率,却不能改善低放射敏感性食管癌患者的生存期。Objective To prospectively compare the efficacy and toxicities of different radiotherapy doses com- bined with concurrent cisplatin in the treatment of inoperable esophageal cancer. Methods From January 2013 to March 2015, newly diagnosed local inoperable esophageal cancer patients in our hospital were treated with conventional three - dimensional conformal radiotherapy, the total dose of radiotherapy was at least 60 Gy and can be escalated up to 70 Gy at most according to the response evaluated by esophageal barium meal examination. The total dose 〈~64 Gy was defined as the low dose group and 〉 64 Gy as the high dose group. Concurrent cisplatin was applied once a week and no more than 7 weeks. Results A total of 60 patients were enrolled. There were 38 patients in the low dose group and 22 patients in the high dose group. The response rates 2 months after the completion of radiotherapy were 92. 1% and 100% in the low - dose group and the high - dose group, but the difference was not significant （ Z2 = 0. 544, P = 0. 461 ）. Median overall survival （mOS）, after follow - up of 19 months （range 2 -50 months） was significantly shorter in the high dose group than the low dose group （ 16. 67 months vs. 27.67 months, P = 0. 048 ）. Multivariate analysis showed that radio- therapy dose was an independent prognostic factor for overall survival. Compared with the low dose group, the high dose group had the tendency to increase radiation esophagitis （ P = 0. 075 ）. Conclusion Total dose of more than 64Gy may increase the incidence of radiation - induced esophagitis but can not improve the overall survival of esophageal cancer pa- tients with low radiosensitivity.

关 键 词：食管癌 同期放化疗 放疗剂量 

分 类 号：R730.55[医药卫生—肿瘤] R735.1[医药卫生—临床医学]