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目的探讨食管癌放射治疗的并发症及其防治方法,为食管癌的治疗提供科学依据。方法选择浙江省金华市中心医院2010年3月~2012年10月收治的食管癌患者71例,随机分为3组,分别给予常规放疗(CRT)、(CRT组,n=24)、调强放疗(IMRT)(IMRT组,n=23)和三维适形放疗(3D-CRT)(3D-CRT组,n=24),总剂量均为60 Gy。观察不同放疗组靶器官的受线量,各种并发症发生情况。结果①3D-CRT组患者肺、心脏和脊髓接受的放射线的剂量[(27.45±10.01)、(15.89±11.12)、(20.37±3.01)Gy]明显低于CRT组[(38.02±11.22)、(25.65±4.89)、(28.58±3.72)Gy]和IMRT组[(33.98±11.43)、(20.98±10.01)、(29.89±3.04)Gy],差异有统计学意义(P<0.05)。②IMRT组和3D-CRT组放射性食管炎的发生率明显高于CRT组(P<0.05),放射性肺炎和放射性气管炎的发生率明显低于CRT组,差异有统计学意义(P<0.05)。③IMRT组和3D-CRT组患者白细胞减少发生率低于CRT组,而白细胞未减少的概率高于CRT组,差异均有高度统计学意义(P<0.01)。结论 3种治疗计划均能满足靶区剂量要求,但IMRT和3D-CRT对周围的正常组织的伤害小,引起的并发症比较轻,适合广泛推广。
Objective To investigate the complications of radiation therapy of esophageal cancer and its prevention and treatment methods to provide a scientific basis for the treatment of esophageal cancer. Methods 71 patients with esophageal cancer who were treated in Jinhua Central Hospital of Zhejiang Province from March 2010 to October 2012 were randomly divided into three groups and received routine radiotherapy (CRT), CRT group (n = 24) The total dose of IMRT (IMRT group, n = 23) and 3D-CRT (3D-CRT group, n = 24) were all 60 Gy. Observe the target organs of different radiotherapy groups by the amount of the line, a variety of complications. Results ① The doses of radiation in the lung, heart and spinal cord in the 3D-CRT group were significantly lower than those in the CRT group [(27.45 ± 10.01), (15.89 ± 11.12), (20.37 ± 3.01) Gy] [(38.02 ± 11.22), (25.65 ± 4.89), (28.58 ± 3.72) Gy and IMRT group (33.98 ± 11.43), (20.98 ± 10.01) and (29.89 ± 3.04) Gy, respectively. There was significant difference between the two groups (P <0.05). ② The incidence of radiation esophagitis inIMRT group and 3D-CRT group was significantly higher than that in CRT group (P <0.05). The incidence of radiation pneumonia and radiation bronchitis was significantly lower than CRT group (P <0.05). ③ The incidence of leukopenia in IMTT group and 3D-CRT group was lower than that in CRT group, while the probability of leukocyte unreduced was higher than that in CRT group (P <0.01). Conclusion All the three treatment plans can meet the target dosage requirements. However, IMRT and 3D-CRT are less harmful to the surrounding normal tissues and cause less complications, which is suitable for wide application.