【摘要】 目的　比较单纯后程加速超分割及在后程加速超分割基础上协同化疗与常规分割放射治疗食管癌的疗效与毒性。方法　将 1 50例胸段食管鳞癌患者随机分成 3个组 ;(1 )常规分割 (CF)组为 5次 /周 ,2 .0Gy/次 ,总量 60Gy;(2 )后程加速超分割 (LCAF)组则先常规照射 30Gy 3周后改 2次 /d ,1 .5Gy/次 ,间隔≥ 6h ,加量至 60Gy ;(3)后程加速超分割协同化疗 (LCAF +C)组 ,在LCAF的同期加用顺铂 2 0mg ,氟尿嘧啶 50 0mg,1次 /周 ,共 5个周期。结果　CF和LCAF及LCAF +C 3个组 1、2、3、4年生存率分别为 54 %、30 %、1 8%、1 8%和 76 %、56 %、44 %、42 %及 82 %、62 %、50 %、44 % ;1、2、3、4年局部控制率分别为 40 %、32 %、2 6 %、2 4 %和 72 %、60 %、56 %、54 %及 78%、66 %、60 %、56 %。 2种率LCAF和LCAF +C组均明显高于CF组 (P <0 .0 1 ) ,LCAF与LCAF +C组间差异无显著性意义 (P >0 .0 5)。急性毒副作用LCAF +C组较CF组严重 ,LCAF组介于二者之间。3个组的晚期并发症及死亡原因无明显差异 ,而LCAF和LCAF +C组死于局部未控或复发的明显低于常规组。结论　LCAF与LCAF +C组均能显著提高食管癌的局部控制率与生存率 ,但毒性增加。同期小剂量化疗没有降低远地转移率更多还原

【Abstract】 Objective To compare the treatment effects and toxicity of late co urse accelerated hyperfractionation radiotherapy (LCAFR), LCAFR plus concurren t chemotherapy (LCAFR+C) and conventional fractionation radiotherapy(CFR) on esop hageal cancer. Methods 150 patients with squamous carcinoma of thoracic esophag us were divided randomly into three groups: 1.CFR group, patients were irradiate d 2.0?Gy/f, 5 times a week, to a total does of 60?Gy. 2. LCAFR group, patients wer e first irradiated with CFR to 30?Gy, then followed by 1.5?Gy/f bid, at more t han 6 hours’ interval, to the total dose of 60?Gy. 3.LCAFR+C group: The radiotherap y technique was the same as the LCAFR group, but weekly 20 mg DDP and 500 mg 5-Fu wer e added simultaneously for 5 weeks. Results All three groups completed their tre atment course. Of CFR, LCAFR and LCAFR+C groups, the 1-,2-,3- and 4-year sur viva l rates were 54%, 30%, 18%, 18%; 76%, 56%, 44%, 42% and 82%, 62%, 50%, 44%. The 1-,2-,3- and 4-year local control rates were 40%, 32%, 26%, 24%; 72%, 60%, 5 6%, 54% and 78%, 66%, 60%, 56%, with obvious better results in the latter two groups (P<0.01),though without any statistical difference between the latter two group s (P>0.05). The acute toxic effect was severer in the LCAFR+C g roup than in the other two, with the difference significant between the LCAFR+C and CFR group, bu t not between the LCAFR and CFR group. The tolerance of the patients to LCAFR wa s better than that of LCAFR+C group. There were no significant differences in la te complications and causes of death between the three groups. The main cause of death was local recurrence and uncontrolled primary disease, which were signifi cantly lower in the LCAFR and LCAFR+C groups than in the CFR group. Conclusions Both late course accelerated hyperfractionation radiotherapy and late course acc elera ted hyperfractionation radiotherapy plus chemotherapy can significantly improve the local control and survival of esophageal cancer, but the latter has increase d toxicity. Concurrent small dose chemotherapy can not lowered the remote metas tatic rate.更多还原