【作者】 沈文斌； 祝淑钗； 王玉祥； 李任； 李娟； 苏景伟；

【Author】 Shen Wen-Bin Zhu Shu-Chai Wang Yu-Xiang Li Ren Li Juan Su Jing-Wei Department of Radiation Oncology, the fourth hospital of Hebei medical university & Hebei provincial tumor hospital, Shijiazhuang, 050011, China

【机构】 河北医科大学第四医院暨河北省肿瘤医院放疗科；

【摘要】 目的:比较全程三维适形与后程三维适形放疗两种方式在食管癌靶区剂量分布、近期疗效及放疗毒副反应方面的区别,以提供食管癌最佳治疗方式。方法:2000年10月至 2003年12月我科收治72例未经手术治疗的食管癌患者。接受全程适形放疗40例,热塑模体位固定,CT扫描模拟定位, 3～5mm层厚,图像经数字化传输,三维重建进入三维适形放疗计划系统(美国CMS公司Focus 3．0),由副主任医师以上的医生勾画靶区:根据食管造影和纤维食管镜显示病变长度以及CT显示的外侵深度范围,同时包括纵隔内肿大淋巴结均定义为GTV;GTV前后左右方向各外放0．5～0．8cm,上下方向各外放2．0cm为CTV;CTV再均匀外放0．5cm为PTV;同时勾画邻近组织和器官如脊髓、气管、心脏及双侧肺;通过剂量-体积直方图(DVH)与平面二维等剂量曲线图选择最佳治疗计划方案;处方剂量50Gy～70Gy／25～35次／5～7周,中位剂量66Gy。接受后程适形治疗32例(前程传统常规2野或 3野放疗,剂量达30Gy～40Gy／15～20次／3～4周后,再行三维适形放疗),总剂量50Gy～76Gy／25～38次／5～7．6周次,中位剂量64Gy。将32例前半程传统常规射野拟合到后程 3D—CRT计划中,以GTV几何中心为归一点计算剂量,观察并记录肺V5、V10、V15、V20、V25、V30、V35、V40及全肺平均受量Dmean;1000、95%、90％的相应靶区体积所接受剂量(GTVD100、GTVD95、GTVD90、CTVD100、 CTVD95、CTVD90、PTVD100、PTVD95、PTVD90);接受50Gy剂量的靶区体积占相应靶区总体积的百分数 (GTVV50、CTVV50、PTVV50);脊髓所接受最大、最小剂量及接受40Gy剂量照射的体积百分数(Dmax、Dmin、V40); 心脏接受45Gy、50Gy剂量照射的体积占整个心脏体积的百分数(V45、V50);气管接收50Gy、60Gy剂量照射的体积占整气管体积的百分数(V50、V60)。利用DVH对物理参数进行评价比较。结果:全程适形组与后程适形组总有效率差异无显著性(P=0．965);全程适形与后程适形组1、2、3年局部控制率分别为86．3％、86．3％、76．7％和86．3％、70． 0％、70．0％(P=0．3779;1、2、3年生存率分别为80．0％, 57．5％、28．8％和71．9％、46．9％、46．9％(P=0．4921)。全程适形组放射性肺炎发生率较后程适形组低(12．5％对 21．9％,P=0．289),但放射性食管炎发生率前组较后组高 (27．5％对18．8％,P=0．385)。全程适形组与后程适形组 GTVD100为(6110．8±599．1)cGy对(5633．4±647．5)cGy、 GTVD95为(6235．9±540．4)cGy对(5799．0±645．5)cGy、 CTVD95为(4103．0±21 15．9)cGy对(3175．9±1667．7) cGy、CTVD90为(5235．8±1704．5)cGy对(4245．6± 1615．1)cGy、PTVV50为(83．0±18．3)％对(73．4± 19．7)％、脊髓V40为(0．22±0．75)％对(5．25±12．71)％, 心脏V45为(8．78±13．02)％对(18．55±19．18)％、V50为 (6．34±10．78)％对(13．77±16．32)％,以上指标两组间差异有显著性(p<0．05)。结论全程三维适形放疗在靶区剂量分布上优于后程三维适形放疗,但两组患者近期生存率、局控率和放疗毒副反应未见明显差别。更多还原

【Abstract】 Objective: To compared the dose distribution of tumor target volume, the lately effect and the radiation side effects in oesophageal carcinoma treated by different 3D-CRT.And supplied the best treatment model for esophageal carcinoma. Methods: From October 2000 to December 2003,72 patients with esophageal carcinoma were treated with 3D-CRT. 40 patients were treated by 3D-CRT to a total dose 50Gy - 70Gy/25 - 35f/5 - 7w, median dose 66Gy, 32 patients were treated by late-course 3D-CRT( first treated by conventional radiotherapy to the dose 30Gy - 40Gy/15 - 20f/3 - 4w,and then treated by 3D-CRT)to a total dose 50Gy - 76Gy/25 - 38f/5 - 7.6w, median dose 64Gy. These radiophysical parameters were evaluated by the Dose-Volume Histogram(DVH). Rssults: The 1-,2-,3-year local control rates in 3D-CRT group were 86.3% , 86.3% , 76.7%,compared to 86.31% , 70.0%, 70.0% in late-course 3D-CRT group ( P = 0.3779 ).The survival rates of 1-,2-,3-year in 3D-CRT group were 80.0%, 57.5%, 28.8%,compared to 71.9%, 46.9%, 46.9% in late-course 3D-CRT group ( P = 0.4921 ).In 3D-CRT group ,the incidence of radiation-induced pneumonitis was lower than that late-course with 3D-CRT group (12.5% vs 21.9%, P =0.289 ). however , the rates of radiation-induced esophagitis in the first group was higher than the later group ( 27.5% vs 18.8%, P = 0.385 XThere were statistical significant in the physical parametes: esophagealGTVD100, GTVD95, CTVD95, CTVD90, PTVV50, spinal cordV40, heartV45 and V50. Conclusion: Compared to the late-course 3D-CRT group, the total 3D-CRT group were showing more exceileder in the dose distribution of target;However,the two group patients have no statistical difference in survival rate, local control rate and radiation side effects.更多还原