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【摘要】 目的 比较后程加速超分割放疗加同期化疗与单纯后程加速超分割放疗治疗食管癌的近期疗效及毒副作用。方法 78例中上段食管癌患者随机分为两组。1)单纯后程加速超分割放疗组36例; 2)后程加速超分割放疗加同期化疗组42例。放疗采用6MVX线外照射,前2/3程常规放射治疗2 Gy/次,1次/d,共40次,后1/3疗程改用加速超分割放射治疗,1.2 Gy/次,2次/d,间隔6 h,全疗程总剂量共65 Gy;化疗采用周剂量紫杉醇全身用药方案,30 mg静脉滴注,每周一放疗前给药1次,共6次,用药前给予预处理。结果 同步放化疗组近期有效率为83.3%,1、3、5年生存率分别为71.4%、42.8%和28.5%;单放组的近期有效率为63.8%,1、3、年生存率分别为47.2%、27.7%和13.8%。经χ�2检验,差异有显著意义,两组毒副作用均可以耐受。结论 以紫杉醇化疗同步后程加速超分割放疗可以提高食管癌的近期有效率及长期生存率,毒副反应所有患者均能耐受。�
【关键词】 食管癌;后程加速超分割放化疗��
Synchronic radiotherapy-chemotherapy compared with radiotherapy alone in patients with upper and middle esophageal cancer
DING Bai-ying, XIE Zhao-hui.Department of Radiation oncology, ChengDe Cancer Hospital chengde, 067000,China
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【Abstract】 Objective To evaluate the toxicity and clinical activity of late course accelerated hyper fractionation radiotherapy plus chemotherapy (LCAHR+C ) and late course accelerated hyper fractionation radiotherapy (LCAHR).Methods 78 patients with mid-upper segment esophageal carcinoma were randomly divided into two groups:1) LCAFR group:36 patients 2)LCAHR+C group:36 patients. Were given with 6Mvx-ray, total tumer close was 40 Gy/20F, with conventional fractionation regimen during the first two-thirds of the course, and followed by lcahr, 1.2 Gy per fraction, twice daily. The total close varied up to 65 Gy. Paclitaxel 30 mg was given through in stravenous dripping for weeky administrated once per week before radiotherapy for 6weeks with premedication of 1 hour intravenous infusion. Results The effective rate of concurrent chemotherapy group was 83.3%,1、3、5 year survival rates were 71.4%、42.8%、28.5;short-term and effective rate of the radiotherapy was 63.8%,1、3 year survival rates were 47.2%、27.7%、13.8%,by chi-square test, the difference was statistically significant, two side effects are tolerable.Conclusion In comparison with HF, the combined treatment tends to promote the survival rate, yet does not increase the late adverse reactions.�
【Key words】
Esophageal cancer; Synchronic radiotherapy-chemotherapy
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笔者自2002年1月开始将78例中上段食管癌患者随机分为单纯后程加速超分割放疗36例,后程加速超分割放疗加同期化疗42例,进行近期疗效比较和毒副反应观察,现将结果报告如下。�
1 资料与方法
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基金项目:承德市科研指导计划项目(项目编号:200621040)�
作者单位:067000河北省承德市肿瘤医院放疗科
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1.1 一般资料 78例患者,男52例,女26例,均经病理切片证实为鳞状细胞癌;年龄 加同期化疗42例。�
1.2 治疗方法 所有患者均应用直线加速器X线外照射,照射野范围包括病灶上下约3～4 cm,野宽6.5～7.5 cm。首先予前后对穿照射,分割剂量2 Gy/次,5次/周。DT40 Gy后缩野,避开脊髓,改为斜野或侧野照射,分割剂量1.2 Gy/次,2次/d(间隔6 h以上),使肿瘤总量达65 Gy左右。若锁骨上肿大淋结未消失,据情况单独设野。治疗前肿大淋巴结最大直径:后程加速超分割放疗加同期化疗组为(2.1±0.5)cm, 单纯后程加速超分割放疗组为(1.9±0.5)cm,经统计学处理,P>0.05,两组差异无显著性。放疗中注意颈髓受照量0.05,两组差异无显著性。观察记录,并对放疗中或结束时转移灶完全消失时的放疗范围进行比较分析:同步放化组为(46.1±6.0) Gy, 单放组为(57.8 ±6.0) Gy,经t检验,有显著性差异,P
