三維適形后程加速超分割聯(lián)合PF方案誘導(dǎo)同期化療治療中晚期食管

1、三維適形后程加速超分割聯(lián)合PF方案誘導(dǎo)同期化療治療中晚期食管癌的臨床觀察 09-05-04 08:38:00 編輯：studa090420 作者：王萬(wàn)偉，于長(zhǎng)華，宋亞頎，萬(wàn)一元【摘要】 目的 評(píng)估三維適形并后程加速超分割聯(lián)合PF方案同期放化療治療中晚期食管癌的臨床療效。方法 病理證實(shí)的中晚期食管癌65例隨機(jī)分為單放組33例和放化組32例；放療均采用6/15MV-X線外照射。各組放療前23療程常規(guī)放療1.8 Gy次，5次周，共40 Gy，后13療程改用加速超分割治療，15 Gy次，2次天，間隔6 h以上，全療程總劑量70 Gy；放化組配合PF方案化療，治療結(jié)束后，按照食管癌診治規(guī)范標(biāo)準(zhǔn)，比較兩組

2、療效，第1、2、3年生存率及毒副反應(yīng)。結(jié)果 單放組CR 36.4%，PR 54.5，1、2、3年生存率分別為39.4、30.3、24.2；放化組CR 43.8，PR 53.1，1、2、3年生存率分別為68.8%、56.3、50.0%，兩者近期療效無(wú)統(tǒng)計(jì)學(xué)差異(P005)，放化組生存率顯著高于單放組(P005)，放化組全身毒副作用高于單放組(P005)。結(jié)論 三維適形后程加速超分割聯(lián)合PF方案治療能明顯提高中晚期食管癌的1、2、3年生存率，且不增加局部毒副反應(yīng)。 【關(guān)鍵詞】 三維適形；后程加速超分割放療；PF方案；食管癌 Abstract：Objective To evaluate the cl

3、inical effects of concurrent chemoradiotherapy with 3D-CRT late-course hyperfractionated accelerated radiation therapy (LCAHF) plus the prognostic factors (PF) project induction on intermediate and advanced esophageal carcinoma. Methods 65 patients pathologically confirmed as having intermediate or

4、advanced esophageal carcinoma were randomly allocated into two groups (33 in radiotherapy group and 32 in complex or chemoradiotherapy group). All patients were given external beam radiation of 6/15 MV X-ray. During the first two-thirds of the course, the patients received a routine dose of 1.8 Gy p

5、er fraction, five times per week, at a dosage of 40 Gy in both groups. For the one-thid that followed, LCAHF was given at a dose of 1.5 Gy, twice daily, at an interval of more than 6 hours, with the total dosage of 70 Gy. In complex group, chemotherapy regimen was combined with DF project. At the en

6、d of treatment, the efficiency, respective survival rates of 1, 2 and 3 years, toxicity as well as side effects between the two groups were compared, based on Guidelines for Diagnosis and Treatment of Esophageal Carcinomas. Results In the radiotherapy group, CR was 36.4% and PR was 54.5%, and in the

7、 complex group, CR was 43.8% and PR was 53.1%, respectively. The 1-, 2-, 3-year survival rates were 39.4%, 30.3%, 24.2% in the radiotherapy group and 68.8%, 56.3%, 50.0% in the complex group, respectively (P0.05), while in the complex group, the regional toxicity and side effects were higher than in

8、 the radiotherapy group (P70分，能進(jìn)半流食，食管病灶長(zhǎng)度10 cm，無(wú)淋巴結(jié)及遠(yuǎn)處轉(zhuǎn)移證據(jù)(鎖骨上及縱隔淋巴結(jié)轉(zhuǎn)移除外)，肝腎功能正常；食管鋇餐無(wú)穿孔、出血征象，估計(jì)手術(shù)切除困難的中晚期患者。剔除標(biāo)準(zhǔn)：治療過(guò)程中出現(xiàn)遠(yuǎn)處轉(zhuǎn)移，其他內(nèi)科疾病導(dǎo)致治療計(jì)劃不能按期完成。臨床分期采用1997年UICC分期標(biāo)準(zhǔn)。 1.2 分組方法 隨機(jī)分為：?jiǎn)渭兒蟪坛指罱M（單放組）33例，單純后程超分割+PF方案化療組（放化組）32例。具體見(jiàn)表1。表1 65例食管癌患者臨床資料 1.3 治療方法 采用西門子電子直線加速器 PRIMUS治療,6/15MV-X，SAD100 cm，適形后程超分

9、割組放療方法包括以下5個(gè)步驟：制作放療體位固定裝置?；颊哐雠P于體模中，雙手上舉交叉置于額部。放療計(jì)劃CT掃描?；颊咴谡婵阵w模固定下做治療體位CT掃描；并在患者體表畫上標(biāo)記圖像經(jīng)數(shù)字化傳輸，三維重建進(jìn)入三維適形治療計(jì)劃系統(tǒng)。三維適形放療計(jì)劃設(shè)計(jì)。根據(jù)食管鋇餐造影和纖維食管鏡顯示病變長(zhǎng)度以及CT顯示的外侵深度范圍，同時(shí)包括縱隔內(nèi)腫大淋巴結(jié)均定義為密集腫瘤區(qū)(GTV)；常規(guī)分割階段GTV上、下外放約4 cm，前后、左右外放051.0 cm作為計(jì)劃靶區(qū)(PTV)，總劑量（DT）：41.4 Gy/23次；加速分割階段GTV上下外放約2.0 cm，前后、左右外放051.0 cm作為PTV，4野照射均避開(kāi)脊髓。1.5 Gy/次,2次/d,間隔6 h以上，DT：65.4 Gy/40次，6.2周完成。2次TPS計(jì)劃融合后評(píng)估超過(guò)20 Gy劑量的肺體積（V20）25，脊髓受量不超過(guò)45 Gy。模擬機(jī)位置驗(yàn)證?；颊哂皿w模固定裝置，按照三維放療計(jì)劃系統(tǒng)（3DTPS）設(shè)定的照射野在模擬機(jī)與計(jì)劃系統(tǒng)（TPS）的數(shù)字重建的射線影像(DRR)進(jìn)行比較，如不能符合，則要分析原因，予以改正。 放化組的放療步驟同單放組，PTV以化療后X線及CT所見(jiàn)病灶外放,外放標(biāo)準(zhǔn)同單放組。 1.4 化療方法 分別于放射治療前第1、5周，應(yīng)用