食管鳞癌后程加速超分割三维适形放疗同期化疗的临床研究

目的：探讨后程加速超分割三维适形放疗同步化疗治疗食管鳞癌病人的疗效和毒副作用。方法：通过随机分组前瞻性临床研究的方法将我科收治的68例食管鳞癌病人分为对照组和试验组,对照组为36例病人,采用单纯后程加速超分割三维适形放疗（Late-course accelerated hyperfractionated three-dimensional conformal radiotherapy,LCAHCRT）,先采用常规分割,剂量达40 Gy时,改为后程加速超分割放疗,每次1.5 Gy,2次/d,间隔大于6 h,总剂量达到60-70 Gy/30-35次。试验组为32例病人,采用上述放疗方法的同时,同步加用化疗顺铂联合氟尿嘧啶。结果：两组有效率分别为试验组96.9%（31/32）,对照组75%（27/36）（P〈0.05）。1、2、3、4a局部控制率试验组为87.5%、78.1%、61.5%和50%,对照组69.4%、50%、30%和22.7%（P〈0.05）。1、2、3、4 a生存率试验组为84.4%、71.9%、53.8%和38.9%,对照组为66.7%、44.4%、26.7%和18.2%（P〈0.05）。毒副作用主要为放射性食管炎、食欲减退和骨髓抑制。试验组的放射性食管炎发生率明显高于对照组（P〈0.05）。结论：对于食管鳞癌病人,后程加速超分割放疗联合同期化疗与单纯后程加速超分割放疗相比,可以提高肿瘤局控率,改善生存期,尽管毒副作用相比较重,但病人耐受性较好。因此,对于一般状况较好的食管鳞癌病人应该推荐使用后程加速超分割放疗联合同期化疗的方法。

CLINICAL STUDY OF LATE-COURSE ACCELERATED HYPERFRACTIONATED THREE-DIMENSIONAL CONFORMAL RADIOTHERAPY WITH CONCURRENT CHEMOTHERAPY FOR ESOPHAGEAL SQUAMOUS CELL CARCINOMA

Objective：To investigate the curative effect and toxicity of late-course accelerated hyper-fractionated three-dimensional conformal radiotherapy and chemotherapy in the treatment of patients with esophageal squamous cell carcinoma in Inner Mongolia. Methods：By the method of randomized prospective clinical study,68 patients with esophageal squamous cell carcinoma from Inner Mongolia were divided into control group and experimental group. The control group included 36 cases,treated by late-course accelerated hyper-fractionated three-dimensional conformal radiotherapy（ Late-course accelerated hyper-fractionated three-dimensional conformal radiotherapy,LCAHCRT）. At the dose of 40Gy,they received late-course accelerated hyper-fractionation radiotherapy,1. 5 Gy each time,2 times a day,more than 6 hour intervals,total dose 60-70Gy/30-35. At the same time of the ra-diotherapy, the test group containing 32 cases, received synchronous chemotherapy. Chemotherapy regimen wasDDP and 5-FU 500 mg. Results：The efficiency rate of the test group was 96. 9%（31/32）,and the rate of the control group was 75%（27/36）. （P〈0. 05）. 1,2,3,4-year local control rate of the test group were 87 . 5%, 78 . 1%, 61 . 5% and 50%. 1 , 2 , 3 , 4-year local control rate of the control group were 69 . 4%,50%,30% and 22 . 7%（ P〈0 . 05 ） . 1 ,2 ,3 ,4-year survival rate of the test group were 84 . 4%,71 . 9%,53 . 8%and 38 . 9%. And the rate of control group were 66 . 7%,44 . 4%, 26. 7% and 18. 2% （P〈0. 05）. The main side effects were radioactive esophagitis,loss of appetite, fatigue and bone marrow suppression. The side effects of the test group were higher than that of the control group （ P〈0. 05 ）. Conclusion：The results demonstrate, for the patients with esophageal squamous cell carcinoma of the Inner Mongolia nationality,radiotherapy and synchronous chemotherapy compared with radiotherapy alone,the curative effect is better than the latter,toxic and side effects of concurrent chemoradiotherapy group are serio