【摘要】 目的　比较连续加速超分割 (CAHF)和后程加速超分割 (LCAF)放射治疗食管癌的疗效和毒性。方法　 10 1例食管鳞癌患者前瞻性随机分成 2个组。LCAF组 (5 2例 )前 2 3疗程为常规分割(5次 周 ,1.8Gy 次 ) ,照射 41.4Gy后缩野改加速超分割 (2次 d ,1.5Gy 次 )照射 2 7Gy ,总量 6 8.4Gy ,41次 ,44～ 46d ,CAHF组 (4 9例 )从治疗开始 ,2次 d ,1.5Gy 次 ,照射至 39Gy后缩野继续原分割方案照射 ,总量 6 6Gy,44次 ,30～ 32d。结果　LCAF组所有病例均完成疗程 ,CAHF组 1例因难以耐受放射性食管炎而终止治疗。LCAF组Ⅰ、Ⅱ、Ⅲ度急性放射性气管炎发生率分别为 13 .5 %、2 1.2 %、3.8%;CAHF组分别为 18.4%、30 .6 %、8.2 %。 2个组差异无显著性意义 (χ2 =3 .72 9,P =0 .2 92 )。LCAF组Ⅰ、Ⅱ、Ⅲ、Ⅳ度急性放射性食管炎发生率分别为 2 6 .9%、32 .7%、7.7%、1.9%;CAHF组分别为 6 .1%、32 .7%、46 .9%、14.3%。 2个组差异有显著性意义 (χ2 =40 .95 2 ,P <0 .0 0 1)。用Kaplan Meier法计算的1、2、3生存率LCAF组为 80 .0 %、5 7.6 %、41.2 %,CAHF组为 79.6 %、5 1.6 %、37.6 %(χ2 =0 .31,P =0 .5 75 7)。 1、2、3年局部控制率 :LCAF组为 80 .7%、71.4%、5 7.1%,CAHF组为 88.7%、79.5 %、5 2 .9%(χ2 =2 .35 0 ,P更多还原

【Abstract】 Objective To compare the result and side effect of continuous accelerated hyperfractionated (CAHF) regimen and late course accelerated hyperfractionated (LCAF) regimen in the radiotherapy for esophageal carcinoma. Methods From Aug.1995 to Mar.1998,101 patients with squamous cell carcinoma of esophagus were randomized into two groups: 52 entered in the LCAF and 49 in the CAHF group. The LCAF group received conventional fractions in the first part of the treatment to a dose of 41.4?Gy/23f/4.6w,followed by accelerated fractionated irradiation using reduced fields, twice daily at 1.5?Gy per fraction with a minimum interval of 6 hours between fractions. The dose by the accelerated technique was 27?Gy, so the total dose was 68.4?Gy/41f/44～46D. The CAHF received 1.5 ?Gy twice a day, 5 days per week right from the beginning , to a total dose of 66?Gy/44f/30～32D.Results All patients in the LCAF group completed the treatment but one in the CAHF group withdrew from the treatment due to severe acute esophagitis. The Ⅰ°,Ⅱ°,Ⅲ° acute trachitis rates in LCAF group were 13.5%, 21.2% and 3.8%, respectively, those in the CAHF group were 18.4%, 30.6% and 8.2% respectively. There is no statistical significance(P=0.292). The incidences of Ⅰ°,Ⅱ°,Ⅲ°, Ⅳ° acute esophagitis in the LCAF group were 26.9%,32.7%,7.7% and 1.9%, respectively ,those in the CAHF group were 6.1%,32.7%,46.9% and 14.3% , respectively. The difference is significant (P<0.001). The local control rates at 1 ,2 and 3 years were 80.7%,71.4%,57.1% in the LCAF group and 88.7%,9.5%,52.9% in the CAHF group(χ 2 =2.35,P=0.125). The survival rates at 1 , 2 and 3 years were 80.0%,57.6%, 41.2% in LCAF group and 79.6%,51.6%, 37.6% in the CAHF group (χ 2=0.31,P= 0.576 ).Conclusions CAHF and LCAF give comparable 1,2,3 year local control rates and survival rates. LCAF having milder acute esophagitis is better tolerated than CAHF. LCAF may be the suitable radiotherapy scheme for concomitant chemotherapy ,which warrants further trial. Both the CAHF and LCAF regimens are superior to the conventional radiotherapy regimen.更多还原