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目的:比较逐级加量全程加速超分割和后程加速超分割治疗食管癌的疗效和副反应。方法:60例符合入组条件的食管鳞癌病例随机分为2组,每组30例。后程加速超分割放疗组(后程组)前4周常规照射40Gy,20次,后2周超分割放疗每天照射2次,间隔6小时以上,30Gy,20次,总剂量Dt70Gy,40次,40~45天;逐级加量全程加速超分割放疗组(全程组)全程超分割放疗,每天照射2次,间隔6小时以上,第1周与第2周每次照射Dt1.2Gy,第3周与第4周每次照射Dt1.4Gy,第5周每次照射Dt1.6Gy,总剂量Dt68Gy,50次,34~38天。结果:随访率为100%。全程组和后程组的1、3、5年局部控制率分别为74.6%、64.9%、59.4%和68.8%、54.7%、33.8%,P=0.099;1、3、5年生存率分别为93.3%、45.0%、33.3%和80.0%、41.6%、23.3%,P=0.077。急性反应和后期损伤无明显差异(P>0.05)。结论:逐级加量全程加速超分割可能提高食管癌放疗的局控率和生存率。正常组织急性反应和晚期放射损伤未增加。该治疗方案能被患者接受。逐级加量全程加速超分割放射治疗食管癌值得研究并可有选择地应用。
OBJECTIVE: To compare the effects and side effects of accelerated hyperfractionation and accelerated hyperfractionation in the treatment of esophageal cancer. Methods: Sixty cases of esophageal squamous cell carcinoma were randomly divided into two groups (n = 30 in each group). 40Gy, 20 times in the first 4 weeks of accelerated hyperfraction radiotherapy (afterward course), 2 times in 2 weeks after radiofrequency, 2 times more than 6 hours, 30Gy, 20 times, total dose of Dt70Gy, 40 times, 40 to 45 days; step-by-step plus full accelerated hyperfractionation radiotherapy group (whole group) full radiotherapy over the whole course of radiation 2 times a day, more than 6 hours interval, the first week and the second week of each exposure Dt1.2Gy, 3 Weeks and 4 weeks each irradiation Dt1.4Gy, the first 5 weeks each irradiation Dt1.6Gy, the total dose of Dt68Gy, 50 times, 34 to 38 days. Results: The follow-up rate was 100%. The local control rates of one, three and five years in the whole course group and the after course group were 74.6%, 64.9%, 59.4% and 68.8%, 54.7% and 33.8%, respectively, P = 0.099; 93.3%, 45.0%, 33.3% and 80.0%, 41.6%, 23.3%, P = 0.077. There was no significant difference between acute reaction and late injury (P> 0.05). Conclusion: Accelerated hyperfractionation by step-by-step dosage may improve the local control rate and survival rate of esophageal cancer radiotherapy. Acute normal tissue reaction and late radiation injury did not increase. The treatment can be accepted by patients. Gradually increase the amount of full-speed hyperspectral radiation treatment of esophageal cancer is worth studying and can be selectively applied.