三维适形后程加速超分割联合PF方案诱导同期化疗治疗中晚期食管

1、三维适形后程加速超分割联合PF方案诱导同期化疗治疗中晚期食管癌的临床观察 09-05-04 08:38:00 编辑：studa090420 作者：王万伟，于长华，宋亚颀，万一元【摘要】 目的 评估三维适形并后程加速超分割联合PF方案同期放化疗治疗中晚期食管癌的临床疗效。方法 病理证实的中晚期食管癌65例随机分为单放组33例和放化组32例；放疗均采用6/15MV-X线外照射。各组放疗前23疗程常规放疗1.8 Gy次，5次周，共40 Gy，后13疗程改用加速超分割治疗，15 Gy次，2次天，间隔6 h以上，全疗程总剂量70 Gy；放化组配合PF方案化疗，治疗结束后，按照食管癌诊治规范标准，比较两组

2、疗效，第1、2、3年生存率及毒副反应。结果 单放组CR 36.4%，PR 54.5，1、2、3年生存率分别为39.4、30.3、24.2；放化组CR 43.8，PR 53.1，1、2、3年生存率分别为68.8%、56.3、50.0%，两者近期疗效无统计学差异(P005)，放化组生存率显著高于单放组(P005)，放化组全身毒副作用高于单放组(P005)。结论 三维适形后程加速超分割联合PF方案治疗能明显提高中晚期食管癌的1、2、3年生存率，且不增加局部毒副反应。 【关键词】 三维适形；后程加速超分割放疗；PF方案；食管癌 Abstract：Objective To evaluate the cl

3、inical effects of concurrent chemoradiotherapy with 3D-CRT late-course hyperfractionated accelerated radiation therapy (LCAHF) plus the prognostic factors (PF) project induction on intermediate and advanced esophageal carcinoma. Methods 65 patients pathologically confirmed as having intermediate or

4、advanced esophageal carcinoma were randomly allocated into two groups (33 in radiotherapy group and 32 in complex or chemoradiotherapy group). All patients were given external beam radiation of 6/15 MV X-ray. During the first two-thirds of the course, the patients received a routine dose of 1.8 Gy p

5、er fraction, five times per week, at a dosage of 40 Gy in both groups. For the one-thid that followed, LCAHF was given at a dose of 1.5 Gy, twice daily, at an interval of more than 6 hours, with the total dosage of 70 Gy. In complex group, chemotherapy regimen was combined with DF project. At the en

6、d of treatment, the efficiency, respective survival rates of 1, 2 and 3 years, toxicity as well as side effects between the two groups were compared, based on Guidelines for Diagnosis and Treatment of Esophageal Carcinomas. Results In the radiotherapy group, CR was 36.4% and PR was 54.5%, and in the

7、 complex group, CR was 43.8% and PR was 53.1%, respectively. The 1-, 2-, 3-year survival rates were 39.4%, 30.3%, 24.2% in the radiotherapy group and 68.8%, 56.3%, 50.0% in the complex group, respectively (P0.05), while in the complex group, the regional toxicity and side effects were higher than in

8、 the radiotherapy group (P70分，能进半流食，食管病灶长度10 cm，无淋巴结及远处转移证据(锁骨上及纵隔淋巴结转移除外)，肝肾功能正常；食管钡餐无穿孔、出血征象，估计手术切除困难的中晚期患者。剔除标准：治疗过程中出现远处转移，其他内科疾病导致治疗计划不能按期完成。临床分期采用1997年UICC分期标准。 1.2 分组方法 随机分为：单纯后程超分割组（单放组）33例，单纯后程超分割+PF方案化疗组（放化组）32例。具体见表1。表1 65例食管癌患者临床资料 1.3 治疗方法 采用西门子电子直线加速器 PRIMUS治疗,6/15MV-X，SAD100 cm，适形后程超分

9、割组放疗方法包括以下5个步骤：制作放疗体位固定装置。患者仰卧于体模中，双手上举交叉置于额部。放疗计划CT扫描。患者在真空体模固定下做治疗体位CT扫描；并在患者体表画上标记图像经数字化传输，三维重建进入三维适形治疗计划系统。三维适形放疗计划设计。根据食管钡餐造影和纤维食管镜显示病变长度以及CT显示的外侵深度范围，同时包括纵隔内肿大淋巴结均定义为密集肿瘤区(GTV)；常规分割阶段GTV上、下外放约4 cm，前后、左右外放051.0 cm作为计划靶区(PTV)，总剂量（DT）：41.4 Gy/23次；加速分割阶段GTV上下外放约2.0 cm，前后、左右外放051.0 cm作为PTV，4野照射均避开脊髓。1.5 Gy/次,2次/d,间隔6 h以上，DT：65.4 Gy/40次，6.2周完成。2次TPS计划融合后评估超过20 Gy剂量的肺体积（V20）25，脊髓受量不超过45 Gy。模拟机位置验证。患者用体模固定装置，按照三维放疗计划系统（3DTPS）设定的照射野在模拟机与计划系统（TPS）的数字重建的射线影像(DRR)进行比较，如不能符合，则要分析原因，予以改正。 放化组的放疗步骤同单放组，PTV以化疗后X线及CT所见病灶外放,外放标准同单放组。 1.4 化疗方法 分别于放射治疗前第1、5周，应用