【作者】 赵快乐； 邓家营； 汪洋； 郭小毛； 姚伟强； 蒋国梁； 施学辉；

【机构】 复旦大学附属肿瘤医院放疗科；

【摘要】 [目的]比较三维适形放疗(3DCRT/IMRT)和常规放疗(2DRT)治疗局部区域性食管鳞癌的长期疗效和副反应。[材料和方法]我院从1996年到2004年进行了4个食管癌根治性放(化)疗的前瞻性研究,从中选出单纯放疗的5个组,共254例患者。158/254(62.2%)使用2DRT,96/254(37.8%)用三维放疗(3DCRT/IMRT)。2DRT的158例患者中,后加速(LCAF)和全程加速超分割(LCAF)的各为109/158(69.0%)和49/158(31.0%)。96例3DCRT/IMRT患者中,LCAF和CAHF分割的各为53/96(55.2%)和43/96(44.8%)。[结果]中位随访时间33.1个月(3.5～96.9个月。3DRT/IMRT组和2DRT组的≥3级急性放射性肺炎为5.3%和13.9%(P=0.031);≥3级急性放射性食管炎的分别为1 1.6%和22.8%(P=0.026)。3DRT/IMRT的1,3和5年局控率分别为84.0%,65.5%和59.8%,与2DRT的88.1%,71.4%和65.9%相似(P=0.412)。3DRT/IMRT的1,3和5年总生存率分别为80.2%,36.3%和31.6%,与2DRT的79.1%,45.6%和32.1%也相似(P=0.629)。[结论]3DCRT/IMRT治疗食管癌的毒性明显较2DRT更低,但局控率和生存率未见明显提高。更多还原

【Abstract】 [Background and purpose]To assess the toxicity and long-term survival of esophageal squamous cell carcinoma(ESCC) who have received three-dimensional conformal radiotherapy(3DCRT) or intensity-modulated radiotherapy(IMRT) versus conventional two-dimensional radiotherapy(2DRT). [Methods and Materials]From 1996 to 2004,254 patients with ESCC from 4 prospective clinical trials at Fudan University Shanghai Cancer Center were treated with definitive radiotherapy alone with 2DRT, 3DCRT or IMRT techniques.158/254(62.2%) used 2DRT,96/254(37.8%) used either 3DCRT or IMRT. Of 158 patients who received 2DRT,109/158(69.0%) and 49/158(31.0%) received late-course accelerated hyperfractionated(LCAF) and continuous accelerated hyperfractionated(CAHF) radiotherapy, respectively.Of%patients who using 3DCRT or IMRT,53/96(55.2%) and 43/96(44.8%) received LCAF and CAHF,respectively.[Results]Median follow-up time was 33.1 months(3.5~96.9 months).The rates of≥Grade 3 acute pneumonitis were 5.3%and 13.9%in the 3DRT/IMRT and 2DRT group,respectively, (P=0.031).The rates of≥Grade3 acute esophagitis were 11.6%and 22.8%in the 3DRT/IMRT and 2DRT group,respectively,(P=0.026).The local control rates at l-,3- and 5-year were 84.0%,65.5%and 59.8%in the 3DRT/IMRT group,and 88.1%,71.4%and 65.9%in the 2DRT group,respectively,(P= 0.412).l-,3-,and 5-year overall survival rates were 80.2%,36.3%and 31.6%in the 3DRT/IMRT group,and 79.1%,45.6%and 32.1%in the 2DRT group,respectively,(P=0.629).[Conclusion]There were fewer incidences of acute pneumonitis and esophagitis in patients with ESCC treated with 3DCRT/ IMRT compared with 2DRT.But,there were no significant improvement in local control and overall survival rates in patients treated with 3DCRT/ IMRT compared with 2DRT.更多还原