CAJ | 학술논문

目的　对近年国内报道的食管癌非常规分次方案进行剂量—效应分析，探索改善放射治疗疗效较合理的方案。方法　收集1989年以来食管癌非常规分次（ICF）照射和以常规剂量分次（CF）作为对照的前瞻性随机分组结果，比较肿瘤局部控制率或（及）生存率。依LQ模式计算各个方案对肿瘤组织的放射生物学效应剂量（BEDT）值，与各自的CF对照组进行剂量—效应比较。结果　超分割（HF）3个组中有2个组疗效显著提高，其BEDT值分别高出5＋、10?Gy；疗效无差异1个组BEDT值降低6.8?Gy。加速超分割（AHF）2个组中1个组BEDT值降低17.2?Gy，疗效无差异；1个组疗效显著提高不能用BEDT值降低11.3?Gy来解释。后程加速超分割（LAHF）的7个组中，疗效显著提高的有6个组，其BEDT值比较不能用于预测LAHF对CF方案的疗效差别。后程加速分割（LAF）1个组BEDT值仅高出2.8?Gy，但1、3年生存率提高非常显著。前程加速分割（EAF）1个组的已知疗终完全缓解率提高的相关因素是剂量高出6.8?Gy。结论　（1）用ICF方案有可能在肿瘤局部控制率、生存率方面显著高于CF60～70?Gy，6～7周方案者。（2）AHF、LAHF和LAF的疗效显著提高不能用该方案的BEDT值来解释和预测，疗效的显著改善不依赖于剂量的增加。（3）照射后使肿瘤细胞集群对放射杀灭再敏感化。（4）LAF能提高治疗获得（TG），是一些ICF方案治疗效应提高的放射生物学基础。
목적　대근년국내보도적식관암비상규분차방안진행제량—효응분석，탐색개선방사치료료효교합리적방안。방법　수집1989년이래식관암비상규분차（ICF）조사화이상규제량분차（CF）작위대조적전첨성수궤분조결과，비교종류국부공제솔혹（급）생존솔。의LQ모식계산각개방안대종류조직적방사생물학효응제량（BEDT）치，여각자적CF대조조진행제량—효응비교。결과　초분할（HF）3개조중유2개조료효현저제고，기BEDT치분별고출5＋、10?Gy；료효무차이1개조BEDT치강저6.8?Gy。가속초분할（AHF）2개조중1개조BEDT치강저17.2?Gy，료효무차이；1개조료효현저제고불능용BEDT치강저11.3?Gy래해석。후정가속초분할（LAHF）적7개조중，료효현저제고적유6개조，기BEDT치비교불능용우예측LAHF대CF방안적료효차별。후정가속분할（LAF）1개조BEDT치부고출2.8?Gy，단1、3년생존솔제고비상현저。전정가속분할（EAF）1개조적이지료종완전완해솔제고적상관인소시제량고출6.8?Gy。결론　（1）용ICF방안유가능재종류국부공제솔、생존솔방면현저고우CF60～70?Gy，6～7주방안자。（2）AHF、LAHF화LAF적료효현저제고불능용해방안적BEDT치래해석화예측，료효적현저개선불의뢰우제량적증가。（3）조사후사종류세포집군대방사살멸재민감화。（4）LAF능제고치료획득（TG），시일사ICF방안치료효응제고적방사생물학기출。
Objective　Results of unconventiioal fractionated (NCF) radiotherapy for esophageal carcinoma are presented to assess its validity. Methods　Fourteen clinical randomized trials , carried out from 1989 to 2000,were collected from the literature for analysis. These unconventional fractionated trials were compared as to their conventrional fractionated (CF) controls of 60～70?Gy/6～7w. Among these 14 trials, 3 were hyperfractionated (HF), 2 accelerated hyperfractionated (AHF), 7 late AHF (LAHF), 1 late AF (LAF) and 1 early AF (EAF). According to the LQ formula with a tumor α/β=10 ?Gy, the radiation biological effective dose value to tumor tissue (BEDT) were calculated in all these schedules, and dose-response analyses were made and compared. Results　Radiation treatment results were superior to those of CF in 2 of the HF trials which gave higher BEDT value of 5+ and 10?Gy, though not significantly different (NS) in 1 which showed a BEDT 6.8?Gy lower. In 2 AHF trials, 1 NS with a BEDT 17.2?Gy lower, 1 gave significantly improved results which could not be explained by BEDT 11.3?Gy lower. For LAHF trials, 6 showed markedly increased local control and/or survival rates which could not be explained by similar BEDT value level to their CF control, and also so in the same 1 LAF trial. BEDT 6.8?Gy higher was the sole known factor for higher complete regression rate in an EAF trial. Conclusions　(1) Some NCF radiotherapy schedules such as HF, AHF, LAHF and LAF can result in better local tumor control and/or survival rates than those of their CF control with 60～70?Gy/6～7week. (2) AHF, LAHF and LAF schedules are able to improve markedly the treatment outcome which may not be explained and predicted by their relative BEDT values to the control, and thus are dose independent. (3) Tumor cells present accelerated repopulation round 4±1 weeks after the start of irradiation, cell cycle phase redistribution, together with reoxygenation, making the tumor cells resensitized to radiation killing. (4) The time that tumor cells reach their highest reproductive capacity after irradiation is at the late course of radiotherapy. Most of the late accelerated schedules initially gave CF of 30～40?Gy/3～4w, then altered to be accelerated, which could increase the therapeutic gain (TG) and improve their treatment results significantly,which is the radiobiological basis for better treatment results of some types of NCF radiotherapy schedules.