【摘要】 目的　评价大野套小野加速超分割与常规分割放射治疗上段食管癌的疗效及预防照射双锁骨上淋巴结的意义。方法　将 76例上段食管癌分为 2个组。常规 (CF)组 37例前大野后 2个野等中心同时照射 ,2 .0Gy/次 ,1次 /d ,5次 /周 ;照射至 40～ 45Gy后缩野照射 ,总剂量达DT6 0～ 6 6Gy ,锁骨上预防照射DT45Gy,总疗程 6～ 7周。超分割 (AF)组 39例 ,1.0～ 1.5Gy/次 ,2次 /d ,间隔 6h ,10次 /周 ;前大野总剂量DT40～ 45Gy,2个后小野等中心照射总剂量DT2 0～ 2 5Gy。结果　完全缓解 (CR)率和总有效 (CR +PR)率AF组分别为 71.8%和 97.4% ;CF组分别为 5 4.1%和 91.9%。 2个组生存率曲线比较差异有显著性意义 (χ2 =5 .6 70 ,P =0 .0 2 5 )。AF组 1、2、3年生存率分别为 82 .0 %、6 1.5 %、48.7% ,CF组分别为 6 4.8%、48.6 %、37.8%。AF组 1、2、3年局部控制率分别为 79.4%、5 3.8%、46 .1% ,CF组分别为 5 6 .7%、45 .9%、37.8%。 2个组 1年局部控制率比较差异有显著性意义 (χ2 =4.5 40 ,P =0 .0 33)。结论　大野套小野加速超分割放射治疗上段食管癌疗效优于常规分割法。更多还原

【Abstract】 Objective To evaluate the therapeatic result of upper esophageal carcinoma treated by accelerated hyperfractionation radiotherapy (AHR) with the field-in-field technique and to define the benefit from prophylactic irradiation of the bilateral supraclavicular and superior mediastinal lymphatics.Methods Seventy-six upper esophageal carcinoma patients were treated with conventional radiotherapy (CRT-37 patients) or accelerated hyperfractionation radiotherapy (AHR-39 patients). The CRT patients were irradiated with a wide anterior portal and two isocentric converging posterior oblique portals at 2 Gy once daily, 5 days per week. After 40-45 Gy,the radiation fields were coned-down and the radiation dose was increased to 60-66 Gy at the primary lesion and 45 Gy in the supraclavicular regions. The AHR patients were treated with the same three-portal technique at 1.0-1.5 Gy per fraction ,twice daily with a minimum interfration interval of 6 hours, 5 days per week. 40-45 Gy were delivered through the large anterior portal and 20-25 Gy through two posterior oblique portals.Results The complete response (CR) rate and total response (CR+PR) rate were 71.8% and 97.4% in the AHR group. They were 54.1% and 91.9% in the CRT group.Comparison between the survival rates of these two groups showed significant difference(χ 2=5.670,P=0.025). The 1-,2-,3-year survival rates were 82.9%,61.5%,48.7% and 64.8% ,48.6%,37.8% in the AHR and CRT groups. The difference in 1-year local control rate between these two groups was statistically significant (χ 2=4.540,P=0.033).Conclusion Accelerated hyperfractionation radiotherapy with the field-in-field technique has a good impact on improving the local control and survival in the treatment of esophageal carcinoma.更多还原