CAJ | 학술논문

背景与目的:对于颈及胸上段食管癌,三维适形放疗(3-dimensional conformal radiation therapy,3D-CRT)并不一定都能满足临床要求,而适形调强放射治疗(intensity modulation radiation therapy,IMRT)又会占用大量的人力物力.中国医学科学院肿瘤医院定义了一种简单调强放疗技术(simplified IMRT,sIMRT).本研究中我们应用sIMRT联合同期化疗治疗颈及胸上段食管癌,并分析急性放射反应和近期疗效.方法:对30例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2个靶区:PTV1,给予64 Gy(2.13 Gy×30次)的照射;PTV2,给予54 Gy(1.8 Gy×30次)的剂量,设计等角度5野sIMRT计划.在开始放疗的第1-5天和第29～33天给予顺铂(DDP)+氟尿嘧啶(5-FU)方案同期化疗2个周期,放疗结束后28天原方案重复2个疗程.结果:患者可在6周内完成治疗计划,5野sIMRT获得了满意的剂量分布,剂量分布和IMRT相似.但明显优于3D-CRT.所有患者完成了治疗计划,治疗中仅1例发生Ⅲ级放射性气管炎,无因放疗反应而中断治疗的患者.食管病灶达完全缓解(complete remission,CR)者27例(90%),部分缓解(partial remission,PR)3例(10%),总有效率达100%:淋巴结病灶达CR者13例,PR 4例.毒性反应主要为Ⅰ～Ⅱ级白细胞下降.结论:sIMRT较复杂调强计划治疗颈胸上段食管癌剂量分布相似.明显优于3D-CRT,近期疗效满意,急性放射反应可耐受,远期疗效及组织损伤尚有待长期随访观察.
배경여목적:대우경급흉상단식관암,삼유괄형방료(3-dimensional conformal radiation therapy,3D-CRT)병불일정도능만족림상요구,이괄형조강방사치료(intensity modulation radiation therapy,IMRT)우회점용대량적인력물력.중국의학과학원종류의원정의료일충간단조강방료기술(simplified IMRT,sIMRT).본연구중아문응용sIMRT연합동기화료치료경급흉상단식관암,병분석급성방사반응화근기료효.방법:대30례경급흉상단식관암적원발조화예방조사구진행sIMRT계화설계.정의2개파구:PTV1,급여64 Gy(2.13 Gy×30차)적조사;PTV2,급여54 Gy(1.8 Gy×30차)적제량,설계등각도5야sIMRT계화.재개시방료적제1-5천화제29～33천급여순박(DDP)+불뇨밀정(5-FU)방안동기화료2개주기,방료결속후28천원방안중복2개료정.결과:환자가재6주내완성치료계화,5야sIMRT획득료만의적제량분포,제량분포화IMRT상사.단명현우우3D-CRT.소유환자완성료치료계화,치료중부1례발생Ⅲ급방사성기관염,무인방료반응이중단치료적환자.식관병조체완전완해(complete remission,CR)자27례(90%),부분완해(partial remission,PR)3례(10%),총유효솔체100%:림파결병조체CR자13례,PR 4례.독성반응주요위Ⅰ～Ⅱ급백세포하강.결론:sIMRT교복잡조강계화치료경흉상단식관암제량분포상사.명현우우3D-CRT,근기료효만의,급성방사반응가내수,원기료효급조직손상상유대장기수방관찰.
Background and Objective: For neck and upper thoracic esophageal carcinoma.three dimensional conformal radiation therapy(3DCRT)does not necessarily meet all clinical requirements while intensity modulated radiation therapy(IMRT)may take up a lot of labour power and material resources.This study was to explore the feasibility of simplified IMPT(sIMRT) and concurrent chemotherapy for neck and upper thoracic esophageal carcinoma,and to jnvestigate the acute toxicities and short-term efficacy of this treatment modality.Methods:sIMRT plans were designed for 30 patients with neck and upper thoracic esophageal carcinoma.Two target volumes were defined:PTV1, which was designed to irradiate to 64 Gy (2.13 Gy×30 fractions);PTV2,which was given to 54 Gy(1.8 Gy × 30).The sIMRT plan included five equiangular coplanar beams. All patients concurrently received DDP+5-FU regimen with radiotherapy on d 1-5 and d29-33. Chemotherapy was repeated for two cycles 28 days after radiotherapy.Results:The treatment was completed for all patients within 6 weeks, and only one patient had Grade 3 acute bronchitis.The complete response(CR)rate was 90.0%(27/30)and the partial response(PR)rate 10.0%(3/30).Overall response was 100%for esophageal lesions and the CR rate 76.5%(13/17).The PR rate was 23.5%(4/17)in lymph node lesions.The major toxicities observed were Grades Ⅰ-Ⅱ leukocytopenia.Conclusions: sIMRT can generate desirable dose distribution for neck and upper thoracic esophageal carcinoma,which is similar to sophisticated IMRT but obviously better than 3D-CRT.The short-term efficacy of sIMRT is satisfactory and its acute toxicities are tolerable.