| 朱卫国,周轲,陶光州,于长华,韩济华,李涛,陈小飞.简单调强高剂量或常规剂量放射治疗伴淋巴结转移的食管癌疗效分析[J].中华放射医学与防护杂志,2011,31(4):460-464 |
| 简单调强高剂量或常规剂量放射治疗伴淋巴结转移的食管癌疗效分析 |
| Efficacy analysis on simplified intensity-modulated radiotherapy with high or conventional dose and concurrent chemotherapy for patients with N1 esophageal carcinoma |
| 投稿时间：2010-11-26 |
| DOI：10.3760/cma.j.issn.0254-5098.2011.04.022 |
| 中文关键词: 食管癌 调强放射治疗 剂量 预后 |
| 英文关键词:Esophageal cancer Simplified intensity-modulated radiotherapy Dose Prognosis |
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| 中文摘要: |
| 目的 探讨简单调强放疗技术(sIMRT)并同期化疗治疗颈段及胸上段食管癌,并予转移淋巴结高剂量放疗的可行性。方法 44例患者随机分为2组,高剂量组20例,常规剂量组24例。对颈及胸上段食管癌的原发灶和预防照射区进行sIMRT计划设计。定义3个靶区: PGTVnd为转移淋巴结靶区,高剂量组患者给予68.1 Gy,每次2.27 Gy,共30次;常规剂量组患者给予60 Gy,每次2.0 Gy,共30次。PTV1为需要加量照射的原发灶靶区,高剂量组给予63.9 Gy,每次2.13 Gy,共30次;常规剂量组60 Gy,每次2.0 Gy,共30次。PTV2为预防照射区,高剂量组和常规剂量组均给予54 Gy,每次1.8 Gy,共30次。放疗中顺铂(DDP)+5-氟尿嘧啶(5-FU)方案第1~5天和第29~33天同期化疗2个周期,放疗结束后28 d原方案重复2个疗程。结果 所有患者均完成了治疗计划,治疗中仅1例发生Ⅲ级放射性气管炎。高剂量组与常规剂量组淋巴结病灶达完全缓解(CR)者分别为75%(15/20)与45.8%(11/24),差异有统计学意义(χ2=3.84,P<0.05);1、2、3年无进展生存率分别为60%、40%、25%和41.7%、25%、8.3%(χ2=4.11,P﹤0.05);原发病灶近期疗效和1、2、3年生存率差异无统计学意义;不良反应主要为Ⅰ~Ⅱ级白细胞下降。结论 sIMRT计划治疗颈及胸上段食管癌,急性放射反应可耐受,给予转移淋巴结高剂量放疗可以提高患者的无复发生存率。 |
| 英文摘要: |
| Objective To investigate the feasibility of simplified intensity-modulated radiotherapy (sIMRT) and concurrent chemotherapy against neck and upper thoracic esophageal carcinoma with lymph node metastasis. Methods sIMRT plans were designed for 44 patients of neck and upper thoracic esophageal carcinoma with lymph node metastasis, 20 of which underwent high dose sIMRT (hsIMRT group) and 24 underwent conventional dose sIMRT (csIMRT group). Three target volumes were defined: PGTVnd, target volume of lymph node lesion, irradiated to 68.1 Gy (2.27 Gy×30 fractions) for the hsIMRT group, and 60 Gy (2.0 Gy×30 fractions) the csIMRT group; PTV1, the target volume of primary lesion, to be irradiate to 63.9 Gy (2.13 Gy×30 fractions) for the hsIMRT group and 60 Gy (2.0 Gy×30 fractions) for the csIMRT group; PTV2, the prophylacticly irradiated volume, to be irradiated to 54 Gy (1.8 Gy×30) for both groups. The sIMRT plan included 5 equiangular coplanar beams. All patients received DDP+5-FU regimen concurrently with radiotherapy at 1 -5 d and 29 -33 d, respectively. Chemotherapy was repeated for two cycles 28 days after the radiotherapy was finished. Results The treatment was completed for all patients within 6 weeks. During the treatment only one patient with grade 3 acute bronchitis was observed in the hsIMRT group. The complete response (CR) rate for the lymph node lesion of the hsIMRT group was 75% (15/20), significantly higher than that of the csIMRT group [45.8%(11/24), χ2=3.84,P<0.05]. The 1-, 2-, and 3-year progression-free survival rates of the hsIMRT group were 60%, 40%, and 25%, respectively,all significantly higher than those of the csIMRT group (41.7%, 25%, and 8.3% respectively, χ2=4.11,P﹤0.05). However, there were not significant differences in the total survival rate, and the CR and PR of the esophageal lesion between these 2 groups. The major toxicity observed was grade Ⅰ-Ⅱ leukoctyopenia. Conclusions sIMRT generates desirable dose distribution for neck and upper thoracic esophageal carcinoma. hsIMRT has a better short-term efficacy than csIMRT. High dose radiotherapy toward metastatic lymph nodes helps increase progression-free survival. |
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