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目的:探讨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毒性。方法:100例符合入组条件的食管鳞癌病例随机分为逐级加量全程加速超分割放疗组(全程组)和后程加速超分割放疗组(后程组)各50例。后程组前4周常规放疗,每天照射1次,DT40Gy,20次,后2周超分割放疗,每天照射2次,每次DT1.5Gy,间隔6～8小时,DT30Gy,总剂量DT70Gy,40次,40～45天;全程组采用全程超分割放疗,每天照射2次,间隔6～8小时,第1、2周每次照射DT1.2Gy,第3、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:全部病例随访率100%。全程组和后程组的1、2、3年局部控制率分别为78.5%、72.8%、70.8%和77.7%、69.1%、55.3%(P=0.054);1、2、3年生存率分别为94%、64%、50%和84%、60%、37%(P=0.049)。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提高了食管癌放疗的局控率,有可能提高长期生存率。正常组织急性反应和晚期放射损伤并没有增加。
OBJECTIVE: To investigate the efficacy and toxicity of escalation of esophageal cancer by step-by-step accelerated hyperfractionation and subsequent accelerated hyperfractionation. Methods: One hundred cases of esophageal squamous cell carcinoma were enrolled in this study. All patients were randomly divided into two groups (50 cases in each group). The latter 4 weeks routine radiotherapy routine irradiation once a day, DT40Gy, 20 times, 2 weeks after radiofrequency radiation treatment, irradiation 2 times a day, each DT1.5Gy, interval 6 ~ 8 hours, DT30Gy, total dose DT70Gy, 40 Times, 40 to 45 days; the whole group using full radiotherapy, irradiation 2 times a day, an interval of 6 to 8 hours, the first and second weeks of exposure to each DT1.2Gy, the first 3,4 weeks of exposure to each 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 of all cases was 100%. The local control rates at 1, 2 and 3 years were 78.5%, 72.8%, 70.8% and 77.7%, 69.1% and 55.3% respectively (P = 0.054) in the whole course group and the latter course group. The 1, 2 and 3 year survival rates were respectively 94%, 64%, 50% and 84%, 60% and 37% (P = 0.049). There was no significant difference between acute reaction and late injury (P> 0.05). CONCLUSION: Accelerated hyperfractionation by step-by-step dosage increases the local control rate of radiotherapy for esophageal cancer and may improve the long-term survival rate. Acute normal tissue reaction and late radiation injury did not increase.