| 王冬青,孙明萍,李宝生,王中堂,魏玉梅.局部进展期食管鳞癌后程加速超分割放疗同步化疗的前瞻性研究[J].中华放射医学与防护杂志,2013,33(6):615-618 |
| 局部进展期食管鳞癌后程加速超分割放疗同步化疗的前瞻性研究 |
| Late course accelerated hyperfractionated radiotherapy plus concurrent cisplatin-based chemotherapy for locally advanced esophageal squamous cell carcinoma |
| 投稿时间：2013-02-21 |
| DOI：10.3760/cma.j.issn.0254-5098.2013.06.012 |
| 中文关键词: 食管鳞状细胞癌 后程加速超分割放疗 化疗 |
| 英文关键词:Esophageal squamous cell carcinoma Late course accelerated hyperfractionated radiotherapy Chemotherapy |
| 基金项目:山东省科技攻关计划（2007Hz102） |
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| 中文摘要: |
| 目的 评价后程加速超分割放疗（LCAHRT）同步以顺铂为基础的化疗（CHT）治疗局部进展期食管鳞状细胞癌（ESCC）的疗效和不良反应。方法 非随机入组46例经病理学证实的ESCC患者，给予食管原发灶、转移淋巴结和高危淋巴引流区常规分割照射40 Gy/20次后，对原发灶和转移淋巴结采用LCAHRT推量照射19.6 Gy/14次，1.4 Gy/次，2次/d，总剂量59.6 Gy/34次。放疗期间同步2周期CHT。依照RECIST 3.0标准评价近期疗效，Kaplan-Meier法计算患者1、3、5年总生存率（OS）和局部控制率（LCR）。RTOG和CTCAE 3.0标准对治疗相关不良反应进行分级。结果 依据AJCC分期，入组患者Ⅱa期有11例、Ⅱb期有3例、Ⅲ期有32例，所有患者完成治疗计划，总有效率91.3%。中位OS为38.5月，1、3、5年OS和LCR分别为78.6%、49.4%、39.9%和84.3%、68.2%、61.4%。≥3级放射性食管炎发生率为23.9%，≥3级血液学毒性包括粒细胞减少（26.1%），血小板减少（13.0%）和血红蛋白减低（10.9%），2例（4.3%）患者出现食管-气管瘘。结论 LCAHRT同步CHT对局部进展期ESCC治疗效果满意，但治疗相关的不良反应较显著。 |
| 英文摘要: |
| Objective To evaluate the treatment efficacy and treatment-related toxicity of late course accelerated hyperfractionated radiotherapy (LCAHRT) combined with cisplatin-based chemotherapy (CHT) for locally advanced esophageal squamous cell carcinoma (ESCC). Methods A total of 46 patients with histologically confirmed ESCC, 11 in the stage Ⅱa, 3 in the stage Ⅱb, and 32 in the stage Ⅲ, underwent conventional fractioned radiation of 40 Gy in 20 fractions on the primary and metastatic lymph nodes, and high-risk lymph node drainage regions, and then the primary and metastatic lymph nodes were irradiated as boost with an additional dose of 19.6 Gy in 14 fractions (1.4 Gy twice a day), and the total prescribed dose was 59.6 Gy in 34 fractions. Two cycles of CHT were administered concurrently during the radiotherapy. The 1-, 3-, and 5-year overall survival (OS) rates and local control rates (LCRs) were evaluated by Kaplan-Meier method, and treatment-related toxicity was analyzed based on the RTOG and CTCAE criteria 3.0. Results All patients received the whole course of treatment. The median follow-up time was 34.4 months (6-67 months). The overall response rate was 91.3% (42/46). The median OS was 38.5 months (95% CI 29.6-47.4 months). The 1-, 3-, and 5-year OS rates and LCRs were 78.6%, 49.4%, and 39.9%, and 84.3%, 68.2%, and 61.4% respectively. The incidence of ≥G3 radiation-induced esophagitis was 23.9%. Three kinds of serious (≥G3) hematologic toxicities were recorded, including leucopenia (26.1%), thrombocytopenia (13.0%), and anemia (10.9%). Esophagotracheal fistula was recorded in 2 patients (4.3%). Conclusion LCAHRT plus CTH can be favorable for the patients with locally advanced ESCC, however, the treatment-related toxicities may be serious. |
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