CAJ | 학술논문

目的评价后程加速超分割放疗(LCAHRT)同步以顺铂为基础的化疗(CHT)治疗局部进展期食管鳞状细胞癌(ESCC)的疗效和不良反应.方法非随机入组46例经病理学证实的ESCC患者,给予食管原发灶、转移淋巴结和高危淋巴引流区常规分割照射40 Gy/20次后,对原发灶和转移淋巴结采用LCAHRT推量照射19.6 Gy/14次,1.4 Gy/次,2次/d,总剂量59.6 Gy/34次.放疗期间同步2周期CHT.依照RECIST 3.0标准评价近期疗效,Kaplan-Meier法计算患者1、3、5年总生存率(0S)和局部控制率(LCR).RTOG和CTCAE 3.0标准对治疗相关不良反应进行分级.结果依据AJCC分期,入组患者Ⅱa期有11例、Ⅱb期有3例、Ⅲ期有32例,所有患者完成治疗计划,总有效率91.3％.中位OS为38.5月,1、3、5年OS和LCR分别为78.6％、49.4％、39.9％和84.3％、68.2％、61.4％.≥3级放射性食管炎发生率为23.9％,≥3级血液学毒性包括粒细胞减少(26.1％),血小板减少(13.0％)和血红蛋白减低(10.9％),2例(4.3％)患者出现食管-气管瘘.结论 LCAHRT同步CHT对局部进展期ESCC治疗效果满意,但治疗相关的不良反应较显著.
목적 평개후정가속초분할방료(LCAHRT)동보이순박위기출적화료(CHT)치료국부진전기식관린상세포암(ESCC)적료효화불량반응.방법 비수궤입조46례경병이학증실적ESCC환자,급여식관원발조、전이림파결화고위림파인류구상규분할조사40 Gy/20차후,대원발조화전이림파결채용LCAHRT추량조사19.6 Gy/14차,1.4 Gy/차,2차/d,총제량59.6 Gy/34차.방료기간동보2주기CHT.의조RECIST 3.0표준평개근기료효,Kaplan-Meier법계산환자1、3、5년총생존솔(0S)화국부공제솔(LCR).RTOG화CTCAE 3.0표준대치료상관불량반응진행분급.결과 의거AJCC분기,입조환자Ⅱa기유11례、Ⅱb기유3례、Ⅲ기유32례,소유환자완성치료계화,총유효솔91.3％.중위OS위38.5월,1、3、5년OS화LCR분별위78.6％、49.4％、39.9％화84.3％、68.2％、61.4％.≥3급방사성식관염발생솔위23.9％,≥3급혈액학독성포괄립세포감소(26.1％),혈소판감소(13.0％)화혈홍단백감저(10.9％),2례(4.3％)환자출현식관-기관루.결론 LCAHRT동보CHT대국부진전기ESCC치료효과만의,단치료상관적불량반응교현저.
Objective To evaluate the treatment efficacy and treatment-related toxicity of late course accelerated hyperfractionated radiotherapy (LCAHRT) combined with cisplatin-based chemotherapy (CHT) for locally advanced esophageal squamous cell carcinoma (ESCC).Methods A total of 46 patients with histologically confirmed ESCC,11 in the stage Ⅱa,3 in the stage Ⅱb,and 32 in the stage Ⅲ,underwent conventional fractioned radiation of 40 Gy in 20 fractions on the primary and metastatic lymph nodes,and high-risk lymph node drainage regions,and then the primary and metastatic lymph nodes were irradiated as boost with an additional dose of 19.6 Gy in 14 fractions (1.4 Gy twice a day),and the total prescribed dose was 59.6 Gy in 34 fractions.Two cycles of CHT were administered concurrently during the radiotherapy.The 1-,3-,and 5-year overall survival (OS) rates and local control rates (LCRs) were evaluated by Kaplan-Meier method,and treatment-related toxicity was analyzed based on the RTOG and CTCAE criteria 3.0.Results All patients received the whole course of treatment.The median followup time was 34.4 months (6-67 months).The overall response rate was 91.3％ (42/46).The median OS was 38.5 months (95％ CI 29.6-47.4 months).The 1-,3-,and 5-year OS rates and LCRs were 78.6％,49.4％,and 39.9％,and 84.3％,68.2％,and 61.4％ respectively.The incidence of ≥ G3 radiationinduced esophagitis was 23.9％.Three kinds of serious (≥G3) hematologic toxicities were recorded,including leucopenia (26.1％),thrombocytopenia (13.0％),and anemia (10.9％).Esophagotracheal fistula was recorded in 2 patients (4.3％).Conclusion LCAHRT plus CTH can be favorable for the patients with locally advanced ESCC,however,the treatment-related toxicities may be serious.