CAJ | 학술논문

目的利用三维适形放疗(3DCRT)技术对中晚期食管癌患者进行后程加速照射,对其疗效和副反应进行观察与分析.方法 55例首程治疗的食管癌患者接受3DCRT,随机分为3DCRT后程加速组(加速组,27例)和3DCRT常规分割组(常规组,28例),常规组处方剂量64～66 Gy分32～33次,加速组处方剂量67～70 Gy分29～30次,第5周开始加速照射3 Gy/次,5次/周.观察两组患者近期疗效、急性副反应及局部控制率、生存率和死亡原因.结果加速组完全缓解率85%、部分缓解率15%、总有效率100%,常规组的分别为57%、43%、100%,加速组优于常规组(χ~2=5.24,P=0.022).两组1～5年局部控制率相似(χ~2=0.68,P=0.409),1～5年生存率也相似(χ~2=0.06,P=0.804).放射性食管炎发生率两组相近(85%:89%;χ~2=0.00,P=0.959),加速组放射性肺炎发生率略高于常规组(67%:43%;χ~2=3.14,P=0.076).加速组和常规组死亡分别为19、21例,其中局部控制失败分别为10、15例,远处转移分别为7、5例.结论食管癌3DCRT后程加速放疗近期疗效满意,与3DCRT常规分割放疗相比局部控制率和远期生存率未见明显提高,后程加速照射有可能增加急性放射性肺及食管损伤但临床尚能接受.
목적 이용삼유괄형방료(3DCRT)기술대중만기식관암환자진행후정가속조사,대기료효화부반응진행관찰여분석.방법 55례수정치료적식관암환자접수3DCRT,수궤분위3DCRT후정가속조(가속조,27례)화3DCRT상규분할조(상규조,28례),상규조처방제량64～66 Gy분32～33차,가속조처방제량67～70 Gy분29～30차,제5주개시가속조사3 Gy/차,5차/주.관찰량조환자근기료효、급성부반응급국부공제솔、생존솔화사망원인.결과 가속조완전완해솔85%、부분완해솔15%、총유효솔100%,상규조적분별위57%、43%、100%,가속조우우상규조(χ~2=5.24,P=0.022).량조1～5년국부공제솔상사(χ~2=0.68,P=0.409),1～5년생존솔야상사(χ~2=0.06,P=0.804).방사성식관염발생솔량조상근(85%:89%;χ~2=0.00,P=0.959),가속조방사성폐염발생솔략고우상규조(67%:43%;χ~2=3.14,P=0.076).가속조화상규조사망분별위19、21례,기중국부공제실패분별위10、15례,원처전이분별위7、5례.결론 식관암3DCRT후정가속방료근기료효만의,여3DCRT상규분할방료상비국부공제솔화원기생존솔미견명현제고,후정가속조사유가능증가급성방사성폐급식관손상단림상상능접수.
Objective To investigate the result and side effect of late course accelerated three-di-mensional conformal radiotherapy (3DCRT) for esophageal carcinoma. Methods From July 2003 to March 2006, 55 patients with esophageal carcinoma receiving 3DCRT were randomly divided into late course accel-erated radiation group (group A, 27 patients) and conventional fractionation group (group B, 28 patients). The prescribed dose in group B was 64 -66 Gy, 2 Gy per fraction, 1 fraction per day, 5 fractions per week for about 6.5 weeks. Patients in group A received conventional fractionation irradiation for the first 4 weeks. Then the dose was increased to 3 Gy per fraction to a total dose of 67 -70 Gy. The treatment course in group A was about 6 weeks. The treatment response, acute site effects, 1-, 3-and 5-year local control rates and o-verall survival rates of the two groups were observed. Results In group A, 23 patients (85%) achievedcomplete response (CR) and 4(15%) achieved partial response (PR). While in group B, 16 patients (57%) achieved CR and 12(43%) achieved PR. The CR rate was significant higher in group A (χ~2 = 5.24,P=0.022). The 1-, 3-, 5-year local control rates were 85%, 54%, 54% in group A, and 70%, 56%, 33 % in group B (χ~2 = 0.68, P = 0.409), respectively. The 1 -,3-,5-year overall survival rates of the two groups were 81%, 37%, 29% and 61%, 39%, 23% (χ~2 = 0.06, P = O. 804), respectively. Both lo-cal control and overall survival were similar between the two groups. The incidences of acute radiation esoph-agitis in the two groups were similar (85% vs. 89% ;χ~2 =0. 00,P=0. 959), and the incidence of radiation pneumonitis was slightly higher in group A than in group B (67% vs 43% ;χ~2 =3.14,P =0.076). By the last follow up, 19 patients in group A and 21 in group B died. Among them, 10 in group A and 15 in group B died of local failure, while 7 in group A and 5 in group B died of metastasis. Conclusions When com-pared with conventional fractionation 3DCRT, late course accelerated 3DCRT for esophageal carcinoma can achieve better results in clinical response, though not in long-term local control or survival. The incidence of acute radiation esophagitis and pneumonitis is clinically acceptable.