CAJ | 학술논문

目的探讨局部晚期食管癌扩大野同期放化疗的疗效及不良反应.方法 101例局部晚期食管癌初治患者入组,其中常规野放疗44例、常规野放化疗29例、扩大野放化疗28例,放疗总剂量60 Gy.常规野临床靶体积(CTV)包括大体肿瘤体积(GTV)外扩0.8 cm、食管原发灶上下各扩3 ～5 cm.扩大野第1阶段CTV包括全食管、GTV外扩0.8cm及淋巴引流区、双侧锁骨上区、胃左淋巴引流区,第2阶段CTV包括GTV外扩0.8 cm、食管原发灶上下各扩3～5 cm,缩野避脊髓.同期化疗包括TP及NP方案.结果 90.1％患者完成放疗计划,同期放化疗患者均完成l周期以上化疗.随访率为99.0％,单纯放疗、同期放化疗的随访时间满2年者分别为24、42例.常规野放疗、常规野放化疗、扩大野放化疗的中位生存时间分别为13、21、19个月,2年总生存率分别为15％、48％、46％,同期放化疗能提高生存率(x2=6.83,P=0.033).同期放化疗3～4级骨髓抑制较单纯放疗发生率高(53％:0％,x2=32.94,P=0.000),其余不良反应(急性放射性肺炎、急性放射性食管炎、食管纤维化、晚期放射性肺损伤)均相似(x2=5.56、6.70、2.39、0.42,P=0.235、0.349、0.881、0.981).结论同期放化疗能提高局部晚期食管癌的生存率,扩大野放化疗是安全的,但是否能提高局部晚期生存率需进一步研究.
목적 탐토국부만기식관암확대야동기방화료적료효급불량반응.방법 101례국부만기식관암초치환자입조,기중상규야방료44례、상규야방화료29례、확대야방화료28례,방료총제량60 Gy.상규야림상파체적(CTV)포괄대체종류체적(GTV)외확0.8 cm、식관원발조상하각확3 ～5 cm.확대야제1계단CTV포괄전식관、GTV외확0.8cm급림파인류구、쌍측쇄골상구、위좌림파인류구,제2계단CTV포괄GTV외확0.8 cm、식관원발조상하각확3～5 cm,축야피척수.동기화료포괄TP급NP방안.결과 90.1％환자완성방료계화,동기방화료환자균완성l주기이상화료.수방솔위99.0％,단순방료、동기방화료적수방시간만2년자분별위24、42례.상규야방료、상규야방화료、확대야방화료적중위생존시간분별위13、21、19개월,2년총생존솔분별위15％、48％、46％,동기방화료능제고생존솔(x2=6.83,P=0.033).동기방화료3～4급골수억제교단순방료발생솔고(53％:0％,x2=32.94,P=0.000),기여불량반응(급성방사성폐염、급성방사성식관염、식관섬유화、만기방사성폐손상)균상사(x2=5.56、6.70、2.39、0.42,P=0.235、0.349、0.881、0.981).결론 동기방화료능제고국부만기식관암적생존솔,확대야방화료시안전적,단시부능제고국부만기생존솔수진일보연구.
Objective To evaluate the efficacy and side effects of extensive regional field radiotherapy concurrent with chemotherapy for locally advanced esophageal cancer.Methods Of the 101 patients with locally advanced esophageal cancer patients,44 patients were treated by involved field radiotherapy alone,29 patients treated by involved field radiotherapy combined with chemotherapy,and 28 patients received extensive regional field radiotherapy combined with chemotherapy,the total dose of radiotherapy was 60 Gy.The clinical target volume (CTV) of involved field included the gross tumor volume (GTV) plus a 0.8 cm lateral margin,the tumor plus a nominal 3-5 cm cephalad and caudal margin.Extensive regional field radiotherapy was delivered in two steps:the CTV included the CTV of the involved field plus elective nodal region in the first step;in the second step,the CTV definition was same with the CTV of the involved field.Synchronous chemotherapy regimens included TP and NP.Results 90.1％patients completed planned radiotherapy,all patients in the concurrent chemotherapy groups completed at least one cycle of chemotherapy.The follow-up rate was 99％.Twenty-four and 42 patients completed followed-up more than 24 months in the radiotherapy alone and concurrent chemoradiotherapy group,respectively.The median survival time of the involved field radiotherapy group,involved field chemoradiotherapy group and extensive regional field chemoradiotherapy group was 13,21 and 19 months,respectively;the 2-year overall survival (OS) rate was 15％,48％ and 46％,respectively for the three groups.The 2-year OS rate was improved significantly in the chemoradiotherapy group (x2 =6.83,P =0.033).Compared with radiotherapy alone group,the incidence of grade three or four bone marrow suppression was higher in the concurrent chemoradiotherapy group (53％: 0 ％,x2 =32.94,P =0.000),the remaining adverse events (acute radiation pneumonitis,acute radiation esophagitis,esophageal fibrosis,late radiation lung injury) had no significant intergroup differences (x2 =5.56,6.70,2.39,0.42,P =0.235,0.349,0.881,0.981).Conclusions Compared with radiotherapy alone,concurrent chemoradiotherapy can improve the survival rate for locally advanced esophageal cancer.The side effects of the extensive regional field radiotherapy combined with chemotherapy is well tolerated.But the efficacy of the extensive regional field radiotherapy combined with chemotherapy needs further research.