CAJ | 학술논문

目的探讨简单调强放疗技术(sIMRT)并同期化疗治疗颈段及胸上段食管癌,并予转移淋巴结高剂量放疗的可行性.方法 44例患者随机分为2组,高剂量组20例,常规剂量组24例.对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3个靶区:PGTVnd为转移淋巴结靶区,高剂量组患者给予68.1 Gy,每次2.27 Gy,共30次;常规剂量组患者给予60 Gy,每次2.0 Gy,共30次.PTV1为需要加量照射的原发灶靶区,高剂量组给予63.9 Gy,每次2.13 Gy,共30次;常规剂量组60 Gy,每次2.0 Gy,共30次.PTV2为预防照射区,高剂量组和常规剂量组均给予54 Gy,每次1.8 Gy,共30次.放疗中顺铂(DDP)+5-氟尿嘧啶(5-FU)方案第1～5天和第29～33天同期化疗2个周期,放疗结束后28 d原方案重复2个疗程.结果所有患者均完成了治疗计划,治疗中仅1例发生Ⅲ级放射性气管炎.高剂量组与常规剂量组淋巴结病灶达完全缓解(CR)者分别为75%(15/20)与45.8%(11/24),差异有统计学意义(x2=3.84,P＜0.05);1、2、3年无进展生存率分别为60%、40%、25%和41.7%、25%、8.3%(x2=4.11,P＜0.05);原发病灶近期疗效和1、2、3年生存率差异无统计学意义;不良反应主要为Ⅰ～Ⅱ级白细胞下降.结论 sIMRT计划治疗颈及胸上段食管癌,急性放射反应可耐受,给予转移淋巴结高剂量放疗可以提高患者的无复发生存率.
목적 탐토간단조강방료기술(sIMRT)병동기화료치료경단급흉상단식관암,병여전이림파결고제량방료적가행성.방법 44례환자수궤분위2조,고제량조20례,상규제량조24례.대경급흉상단식관암적원발조화예방조사구진행sIMRT계화설계.정의3개파구:PGTVnd위전이림파결파구,고제량조환자급여68.1 Gy,매차2.27 Gy,공30차;상규제량조환자급여60 Gy,매차2.0 Gy,공30차.PTV1위수요가량조사적원발조파구,고제량조급여63.9 Gy,매차2.13 Gy,공30차;상규제량조60 Gy,매차2.0 Gy,공30차.PTV2위예방조사구,고제량조화상규제량조균급여54 Gy,매차1.8 Gy,공30차.방료중순박(DDP)+5-불뇨밀정(5-FU)방안제1～5천화제29～33천동기화료2개주기,방료결속후28 d원방안중복2개료정.결과 소유환자균완성료치료계화,치료중부1례발생Ⅲ급방사성기관염.고제량조여상규제량조림파결병조체완전완해(CR)자분별위75%(15/20)여45.8%(11/24),차이유통계학의의(x2=3.84,P＜0.05);1、2、3년무진전생존솔분별위60%、40%、25%화41.7%、25%、8.3%(x2=4.11,P＜0.05);원발병조근기료효화1、2、3년생존솔차이무통계학의의;불량반응주요위Ⅰ～Ⅱ급백세포하강.결론 sIMRT계화치료경급흉상단식관암,급성방사반응가내수,급여전이림파결고제량방료가이제고환자적무복발생존솔.
Objective To investigate the feasibility of simplified intensity-modulated radiotherapy (sIMRT) and concurrent chemotherapy against neck and upper thoracic esophageal carcinoma with lymph node metastasis.Methods sIMRT plans were designed for 44 patients of neck and upper thoracic esophageal carcinoma with lymph node metastasis, 20 of which underwent high dose sIMRT (hsIMRT group) and 24 underwent conventional dose sIM RT (csIMRT group).Three target volumes were defined:PGTVnd, target volume of lymph node lesion, irradiated to 68.1 Gy ( 2.27 Gy × 30 fractions ) for the hsIMRT group, and 60 Gy (2.0 Gy ×30 fractions) the csIMRT group; PTV1, the target volume of primary lesion, to be irradiate to 63.9 Gy (2.13 Gy × 30 fractions) for the hsIMRT group and 60 Gy (2.0 Gy × 30fractions) for the csIMRT group; PTV2 , the prophylacticly irradiated volume, to be irradiated to 54 Gy (1.8 Gy ×30) for both groups.The sIMRT plan included 5 equiangular coplanar beams.All patients received DDP + 5-FU regimen concurrently with radiotherapy at 1 -5 d and 29- 33 d, respectively.Chemotherapy was repeated for two cycles 28 days after the radiotherapy was finished.Results The treatment was completed for all patients within 6 weeks.During the treatment only one patient with grade 3 acute bronchitis was observed in the hsIMRT group.The complete response (CR) rate for the lymph node lesion of the hsIMRT group was 75% ( 15/20 ), significantly higher than that of the csIMRT group [45.8% ( 11/24), x2 = 3.84, P ＜ 0.05].The 1-, 2-, and 3-year progression-free survival rates of the hsIMRT group were 60%, 40%, and 25% , respectively,all significantly higher than those of the csIMRT group (41.7%, 25%, and 8.3% respectively, x2 = 4.11,P ＜ 0.05).However, there were not significant differences in the total survival rate, and the CR and PR of the esophageal lesion between these 2 groups.The major toxicity observed was grade Ⅰ -Ⅱ leukoctyopenia.Conclusions sIMRT generates desirable dose distribution for neck and upper thoracic esophageal carcinoma.hsIMRT has a better short-term efficacy than csIMRT.High dose radiotherapy toward metastatic lymph nodes helps increase progression-free survival.