影像引导后程加速超分割调强适形放疗联合奈达铂治疗食管癌的临床观察  

Image-guided Late Course Accelerated Hyperfraction Intersity-Modulated Radiotherapy Combined with Nedaplatin Chemotherapy for Esophageal Cancer

作　　者：罗宏涛 魏世鸿[2] 刘锐锋[1] 张秋宁 董玉梅 徐丽君[2] 王小虎[1,2,3,4] LUO Hong-tao;WEI Shi-hong;LIU Rui-feng;ZHANG Qiu-ning;DONG Yu-mei;XU Li-jun;WANG Xiao-hu(Institute of Modem Physics,Chinese Academy of Sciences,Lanzhou 743019,China;Gansu Tumor Hospital,Lanzhou 730050,China;The First Clinical Medical College of Lanzhou University,Lanzhou 743019,China;Lanzhou Heavy Ion Hospital,Lanzhou 743019.China)

机构地区：[1]中国科学院近代物理研究所,甘肃兰州743019 [2]甘肃省肿瘤医院,甘肃兰州730050 [3]兰州大学第一临床医学院,甘肃兰州743019 [4]兰州重离子医院,甘肃兰州743019

出　　处：《中国肿瘤》2020年第8期634-640,共7页China Cancer

基　　金：甘肃省科技支撑计划-社会发展类项目(1604FKCA109);2017年兰州市人才创新创业项目(2017-RC-23)。

摘　　要：[目的]观察影像引导后程加速超分割放疗联合奈达铂化疗治疗食管癌的有效性及安全性。[方法] 2016年1月至2017年3月60例食管癌初治患者按照随机数字表法分为后程加速超分割放疗联合奈达铂化疗(观察组)和后程加速超分割放疗联合多西他赛+顺铂化疗(对照组),各30例,放疗采用影像引导调强适形精确放疗技术,6MV-X线,4~5个共面或非共面适形照射野,前程GTV和GTVnd总剂量44Gy,2.2Gy/次,共20次,CTV总剂量36Gy,1.8Gy/次,共20次,5次/周;后程GTV和GTVnd总剂量18Gy,1.5Gy/次,共12次,CTV总剂量13.2Gy,1.1Gy/次,共12次。化疗:观察组单药奈达铂40mg/m^2静脉滴注,放疗期间1次/周。对照组:多西他赛60mg/m^2静脉滴注d1,顺铂25mg/m^2静脉滴注d1-3,放疗第1、28天开始化疗。比较两组近期有效率、不良反应发生率、局控率和生存率。[结果]两组近期疗效评价差异无统计学意义(P>0.05);观察组与对照组中位局部控制时间分别为(24.0±4.1)个月(95%CI:15.9~32.1)和(26.0±2.2)个月(95%CI:21.7~30.2),1-、2-、3-年局部控制率分别为80.0%、53.3%、33.3%和76.7%、63.3%、36.7%(χ~2=0.575,P=0.448),中位生存期分别为(27.0±3.4)个月(95%CI:20.4~33.6)和(32.0±3.0)个月(95%CI:26.2~37.8),1-、2-、3-年生存率分别为83.3%、66.7%、40.0%和86.7%、70.0%、46.7%(χ~2=0.425,P=0.515)。观察组心脏、肾脏和放射性食管炎不良反应发生率均低于对照组(P=0.036、0.038、0.032),胃肠道反应及血液学不良反应无差异。[结论]影像引导后程加速超分割调强适形放疗同步奈达铂周化疗治疗食管癌有效性与后程加速超分割放疗同步多西他赛联合顺铂方案相似,安全性更优于放疗同步两药联合方案。[Purpose] To observe the efficacy and safety of image-guided late course accelerated hyperfraction intensity-modulated radiotherapy(IG-LCAHFIMRT) combined with nedaplatin chemotherapy in the treatment of esophageal cancer. [Methods] From January 2016 to March 2017,60 patients with esophageal cancer were randomly divided into two groups:IG-LCAHFIMRT combined with nedaplatin chemotherapy(study group) and IG-LCAHFIMRT combined with docetaxel + cisplatin chemotherapy(control group) with 30 cases in each group. Radiotherapy was performed with image-guided intensity-modulated conformal precision radiotherapy,6MV-X lines,4 or 5 coplanar or non-coplanar conformal radiation fields. The first course with conventional fraction for GTV and GTVnd 44Gy,2.2 Gy per fraction,20 fractions,CTV 36Gy,1.8Gy per fraction,20 fractions,5 fractions per week,later course with hyperfraction for GTV and GTVnd 18Gy,1.5Gy per fraction,12 fractions,CTV13.2Gy,1.1Gy per fraction,12 fractions. The study group received nedaplatin 40 mg/m2 i.v,once/week during radiotherapy,while the control group received docetaxel 60 mg/m2/day i.v. on d1,cisplatin 25 mg/m2 was injected intravenously on d1-3,and chemotherapy began on the d1 and d28 of radiotherapy. The short-term efficacy rate,incidence of adverse reactions,local control rate and survival rate were compared between the two groups. [Results] There was no significant difference in short-term efficacy between the two groups(P>0.05).The median local control time of the study group and the control group was 24.0±4.1 months(95%CI:15.9~32.1) and 26.0±2.2 months(95%CI:21.7 ~30.2),and the 1-,2-and 3-year local control rates were 80.0%,53.3%,33.3% and76.7%,63.3%,36.7% respectively(χ2=0.575,P =0.448). The median survival time was 27.0 ±3.4 months(95%CI:20.4~33.6) and 32.0±3.0 months(95%CI:26.2~37.8),and the 1-,2-and 3-year survival rates were 83.3%,66.7%,40.0% and 86.7%,70.0%,46.7%,respectively(χ2=0.425,P =0.515).The incidence of adverse reactions in heart,kidney and radiation esophagitis in the study gr

关 键 词：食管肿瘤 后程加速超分割 影像引导 调强放疗 同步放化疗 

分 类 号：R735.1[医药卫生—肿瘤]