后程加速超分割三维适形放疗同步FP方案治疗食管癌疗效分析

目的观察食管癌单纯后程加速超分割三维适形放疗和后程加速超分割三维适形放疗合并同期化疗的近期疗效、生存期及毒副反应。方法将103例食管癌患者根据入选标准随机分为单纯后程加速超分割三维适形放疗组(单放组)53例,后程加速超分割三维适形放疗合并同期化疗组(放化组)50例。单放组全程放疗均采用三维适形,40Gy/20F后重新CT模拟定位,之后改为1.5Gy/F,2F/d,两次间隔>6h,总剂量是62.5～70Gy。放化组放疗同单放组,化疗在放疗的第1天开始,顺铂20mg/(m2.d),5d,氟尿嘧啶500mg/(m2.d),5d,4周为1个疗程,共4个疗程。结果放化组与单放组完全缓解率分别为39.8%、31.5%(P<0.05)。2、3年局部控制率放化组为88.9%、79.1%,单放组79.8%、71.3%(P<0.05)。2、3年生存率两组分别为65.3%、49.6%和56.7%、35.7%(P=0.101)。放化组治疗毒性反应大于单放组,但患者均可耐受。结论以FP方案配合后程加速超分割三维适形放疗治疗食管癌近期疗效和局部控制率均明显提高,有进一步提高远期生存率可能,虽毒副作用增加但能耐受。

Late-course accelerate hyperfractionated three-dimensional radiotherapy combined with concurrent chemotherapy for esophageal carcinoma with result and prognostic analysis

Objective To evaluate the role of late-course accelerated hyperfractionated three-dimensional radiotherapy(LCAF3DCRT) combined with concurrent chemotherapy in the managemet of esophageal carcinoma.Methods Total 103 esophageal carcinoma patients were divided randomly into LCAF3DCRT alone group(LCAF3DCRT,53 patients)or LCAF3DCRT plus concurrent chemotherapy group(LCAF3DCRT-CT,50 patients).The radiotherapy regimen was identical in the two groups,treated by conventional fractionated radiotherapy during the first two-thirds of the course with 40Gy/20 fraction/4 weeks,then followed by hyperfraction 3DCRT,1.5Gy per fraction,2 fraction/d,to a total dose of 62.5~70 Gy.Chemotherapy regimen consisted of four cycles of cisplatin 20mg/(m2.d)plus fluorouracil 500mg/(m2.d)on day 1 to 5 every 4 weeks and was delivered on the first day of radiotherapy.Results Complete response rate in group LCAF3DCRT-CT was 39.8%,while in group LCAF3DCRT,it was 31.5%(P<0.05).The 2-and 3-year local control rate in group LCAF3DCRT-CT was 88.9% and 79.1% while in group LCAF3DCRT,it was 79.8% and 71.3% respectively;The 2-and 3-year survive rate in group LCAF3DCRT-CT was 65.3% and 49.6%,while in group LCAF3DCRT,it was 56.7% and 35.7%(P=0.101) respectively.The acute toxic effect was severer in group LCAF3DCRT-CT than in group LCAF3DCRT.Conclusion Late-course accelerated hyperfractionated three-dimensional radiotherapy combined with concurrent chemotherapy,being able to improve the complete response rate,may have the potential of improving the survival rate of esophageal carcinoma,but it can also increase the acute toxic effect.