摘要
背景与目的:后程加速超分割放疗提高了局控率和生存率,但急性不良反应也相应增加。本研究探索哪些食管癌患者会从后程加速超分割放疗中受益。方法:对84例局部区域性食管癌进行单纯放疗,前2/3程行常规分割,每次DT1.8～2Gy,每周5次,前后野同中心照射DT40～41.4Gy/20～23次,4～4.6周,完成后行食管摄片评估。无效者(郑州标准3+4级)32例(无效组),行后程加速超分割放疗,1.5Gy/次,2次/d,间隔6h,每周5d,总剂量DT65.4～67Gy/38～39次,5.8～6.2周。有效者52例(1+2级)随机分为两组,一组继续常规分割放疗(有效CF组),一组改为后程加速超分割放疗(有效LCAF组),每组各26例。有效CF组总剂量DT60～64Gy/30～34次,6～6.8周。有效LCAF组照射方法及剂量同无效组。结果:无效组1、2和3年局控率分别为65.6%、53.1%和37.5%;1、2和3年生存率分别为56.2%、31.2%、25.0%;有效CF组和LCAF组1、2、3年局控率分别为84.6%、73.1%、69.2%和88.5%、76.9%、69.2%,有效两组相比差异无显著性(P>0.05),而1、2、3年生存率分别为73.1%、42.3%、34.6%和76.9%、46.2%、38.5%,有效两组相比差异亦无显著性(P>0.05)。无效组Ⅰ+Ⅱ级急性放射性食管炎发生率为50%,有效CF组为19.2%,有效LCAF组为53.8%,有效两组间差异有显著性(P<0.05)。无效组Ⅲ级急性放射性食管炎发生率为12.5%,有效CF组为3.85%,有效LCAF组为11.5%,有效两组间差异有显著性(P<0.05)。结论:放疗40Gy时食管摄片评估疗效较好的食管癌患者采用后程加速超分割放疗并没有进一步提高疗效。从后程加速超分割放疗中获益的患者可能是疗效较差的病例。最后的结论需要进一步扩大样本量和更长的随访时间。
Background and purpose： Late course accelerated hyperfractionation radiotherapy（LCAF） can improve the local control rate and survival rate, but acute toxic effect was severe.The trial investigated who would get benefit from LCAF. Methods： From May 2000 to Mar 2001, a randomized trial was carried out in our hospital. 84 patients were treated by conventional fractionated（CF） radiation of 1.8-2 Gy/FX to a total dose of 40-41.4 Gy in 20-23 fractions over 28-32 days;NR＋DR patients received hyperfractionated radiation（LCAF）（no-response group）. CR＋PR patients whose responses were were randomized to response-CF group and response-LCAF group. The patients in response-CF group received conventional radiation again to a total dose of 60-64 Gy in 30-34 fractions over 42-46 days. In Response-LCAF Group received accelerated fractionation irradiation at 1.5 Gy per fraction, twice a day, to a total dose of 65.4-67 Gy in 38-39 fractions over 39-43 days. Results： The local control rates at 1,2,3 years were 66%,53%,38% in the no-response group,85%,73%,69% in the response-CF group and 89%,77%,69% in the response- LCAF group,respectively. The 1-,2-,3-year survival rates were 56%,31%,25% in the no-response group, 73%,42%,35% in the response-CF group and 77%,46%,39% in the response-LCAF group, respectively.There was no significant differentce between two response groups（P〉0.05）.The acute toxicity was more severe in the no-response group and response-LCAF group than in the response-CF group. Conclusion： LCAF did not improve the local control rate and survival rate on grades Ⅰ ＆ Ⅱ esophageal carcinoma when 40Gy had been given by CF. Grades Ⅲ＆Ⅳ esophageal carcinoma will get benefit from LCAF.
出处
《中国癌症杂志》
CAS
CSCD
北大核心
2009年第2期142-144,共3页
China Oncology
关键词
食管肿瘤/放射疗法
放射剂量分次
预后
esophageal neoplasms/radiotherapy
dose fractionation
prognosis
