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目的 分析临床T2N0M0胸上中段食管癌后程加速超分割放射治疗的疗效、副反应及失败原因。方法 回顾分析后程加速超分割放射治疗临床分期T2N0M0胸上、中段食管鳞癌 5 3例 ,放射方法均为前 2 / 3疗程常规放疗 ,每次 1.8Gy,共 41.4Gy左右 ;后 1/ 3疗程缩野改为加速超分割放射治疗 ,每天 2次 ,1.5Gy/次 ,共 2 7Gy左右。全疗程 40～ 49d ,总剂量为 6 7～ 70Gy/ 40～ 43Fx。结果5 3例患者 1,2 ,5年生存率分别为 89.9%、6 6 .8%和 5 1.2 % ;1,2 ,5年局控率分别为 92 .1%、87.1%和87.1%。死亡 17例 ,其中死于未控和局部复发 5例 ,占 2 9.4% ;远处转移 9例 (含 2例伴有淋巴结转移 ) ,占 5 2 .9% ;淋巴结转移 5例 (含 2例伴有远处转移 ) ,占 2 9.4% ;食管出血 1例 ,占 5 .9%。多因素分析显示 ,病变部位是其独立的预后因素 ,胸上段优于胸中段。结论 后程加速超分割放射治疗可作为治疗胸上、中段早期食管鳞癌的首选方法之一。
Objective To analyze the clinical effects, side effects and failure reasons of the late course of T2N0M0 esophageal cancer accelerated hyperfractionation radiotherapy. Methods We retrospectively analyzed 53 cases of advanced stage T2N0M0 thoracic and middle esophageal squamous cell carcinoma with late-stage accelerated hyperfraction radiotherapy. The radiotherapy methods were all conventional radiotherapy of 2 Gy and 3 Gy, Treatment shrink to accelerated hyperfractionated radiotherapy, 2 times a day, 1.5Gy / time, a total of about 27Gy. The whole course of treatment 40 ~ 49d, the total dose of 6 7 ~ 70Gy / 40 ~ 43Fx. Results The 1-, 2-, and 5-year survival rates of 53 patients were 89.9%, 66.8% and 52.2%, respectively. The rates of 1, 2 and 5-year local control were 92.1%, 87.1% and 87.1% respectively. Among them, 17 died, of which 5 died of uncontrolled and local recurrence, accounting for 2 9.4%; distant metastasis 9 cases (including 2 cases with lymph node metastasis), accounting for 52.9%; lymph node metastasis in 5 cases (including 2 cases Accompanied by distant metastasis), accounting for 2 9.4%; esophageal bleeding in 1 case, accounting for 5.9%. Multivariate analysis showed that the lesion site was an independent prognostic factor, superior to superior thoracic segment in the upper thoracic segment. Conclusions Late-course accelerated hyperfractionated radiation therapy is one of the preferred methods for the treatment of early stage esophageal squamous cell carcinoma in the upper and middle stages.