CAJ | 학술논문

背景与目的:食管癌调强放射治疗临床研究国内外报道较为少见,其临床疗效如何,是否会引起较为严重的大范围低剂量照射肺损伤等问题亦无成熟经验.本研究旨在评价调强放疗技术对食管癌的初期疗效及治疗不良反应.方法:2006年6月至2008年3月,采用调强放疗技术治疗37例颈段、胸段食管癌,评价肿瘤反应率、肿瘤局部控制率、生存率和治疗相关不良反应.结果:全组患者100%肿瘤区(gross tumor volume,GTV)、95%临床靶区(clinical target volume,CTV)和95%计划靶区(planning target volume,PTV)接受剂量分别为(6 456±172)cGy、(6 293±145)cGy和(5 988±53)cGy.接受≥5 Cy、≥10 Gy、≥20 Gy、≥30 Gy的肺组织占全肺体积的百分比和肺平均剂量分别为(59.6±12.8)%、(39.5±8.7)%、(22.0±5.4)%、(12.0±4.3)%和(1 178±248)cGy.肿瘤总反应率为97.3%(36/37).中位随访时间为13个月(8～29个月),3级及以上急性和晚期放射性食管损伤发生率分别为16.2%和7.2%;2级及以上急性和晚期放射性肺损伤发生率分别10.8%和8.1%.1、2年肿瘤局部控制率分别为72.9%、72.9%;1、2年总生存率分别为80.9%、67.4%;1、2年无瘤生存率分别为73.5%、51.4%.局部未控和复发占总治疗失败的69.2%.结论:食管癌调强放射治疗初期疗效较好,急性和晚期放射性肺损伤发生率较低.治疗失败的主要原因仍为肿瘤局部未控和复发.
배경여목적:식관암조강방사치료림상연구국내외보도교위소견,기림상료효여하,시부회인기교위엄중적대범위저제량조사폐손상등문제역무성숙경험.본연구지재평개조강방료기술대식관암적초기료효급치료불량반응.방법:2006년6월지2008년3월,채용조강방료기술치료37례경단、흉단식관암,평개종류반응솔、종류국부공제솔、생존솔화치료상관불량반응.결과:전조환자100%종류구(gross tumor volume,GTV)、95%림상파구(clinical target volume,CTV)화95%계화파구(planning target volume,PTV)접수제량분별위(6 456±172)cGy、(6 293±145)cGy화(5 988±53)cGy.접수≥5 Cy、≥10 Gy、≥20 Gy、≥30 Gy적폐조직점전폐체적적백분비화폐평균제량분별위(59.6±12.8)%、(39.5±8.7)%、(22.0±5.4)%、(12.0±4.3)%화(1 178±248)cGy.종류총반응솔위97.3%(36/37).중위수방시간위13개월(8～29개월),3급급이상급성화만기방사성식관손상발생솔분별위16.2%화7.2%;2급급이상급성화만기방사성폐손상발생솔분별10.8%화8.1%.1、2년종류국부공제솔분별위72.9%、72.9%;1、2년총생존솔분별위80.9%、67.4%;1、2년무류생존솔분별위73.5%、51.4%.국부미공화복발점총치료실패적69.2%.결론:식관암조강방사치료초기료효교호,급성화만기방사성폐손상발생솔교저.치료실패적주요원인잉위종류국부미공화복발.
Background and Objective:Intensity-modulated radiotherapy (IMRT)for esophageal carcinoma has seldom been reported; its clinical efficacy and toxicity are still uncertain. This study was to evaluate the shortterm efficacy of IMRT on esophageal carcinoma,and to observe adverse events. Methods: From June 2006 to March 2008, 37 patients with cervical and thoracic esophageal carcinoma were treated with IMRT. The treatment response,local control and survival were evaluated and the adverse events were observed. Results: The minimal prescription dose of 100% of gross tumor volume (GTV D_(100)) 95% of clinical target volume (CTV D_(95)),and 95% of planning target volume (PTV D_(95)) were (6 456±172)cGy, (6 293±145)cGy,and (5 988±53)cGy,respectively. The volumes of lung receiving irradiation of ≥5 Gy,≥10 Gy, ≥20 Gy and ≥30 Gy were (59.6±12.8)%, (39.5±8.7)%,(22.0±5.4)%, and (12.0±4.3)%, respectively. The mean lung dose (MLD)was (1 178±248)cGy. The overall response rate was 97.3% (36/37). The patients were followed-up for 8-29 months(median,13 months). The occurrence rates of grades 3-4 acute and late esophagitis,grades 2-4 acute and late pneumonitis were 16.2% and 7.2%,10.8% and 8.1%.The 1-and 2-year local control rates were 72.9% and 72.9%. The 1-and 2-year overall survival rates were 80.9% and 67.4%. The 1-and 2-year disease-free survival rates were 73.5% and 51.4%. Local recurrence(69.2%) was the main reason of treatment failure. Conclusion: IMRT is an effective treatment for esophageal carcinoma with low occurrence of acute and late radiation-related pneumonitis,but local failure is still a main problem for treatment of patients with esophageal carcinoma.