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目的:比较食道癌后程加速超分割放射治疗和同步放化疗的疗效和毒副反应。方法:全组65例患者随机分为后程加速放疗组(简称后超组)和同步放化疗组(简称放化组)。前4周两组治疗方法相同,用钴-60远距离治疗机,常规分割放疗,1·9Gy/次,每日一次,总剂量39·9Gy后,后程加速组改为每次1·5Gy,每日二次,照射总量63·9~66·9Gy;同步放化疗组全程常规分割放疗,照射总量62·7~66·5Gy,放疗第四周加FP方案化疗:DDP20mg/m2,静滴,第1~4天,5-FU500mg/m2,第1~4天。治疗结束1月后摄食道钡餐片评价近期疗效。结果:全部病例有1例失访,随访率98%。中位随访时间:后超组22月(2月~42月),放化组21月(4月~48月),后超组和放化组的1、3年生存率分别是74·87%、75%和43·5%、31·87%,P>0·05,统计学上无显著性差异。食道急性反应:后超组0级29·03%,1级38·7%,2级22·58%,3级9·67%;放化组0级38·23%,1级47·05%,2级11·76%,3级2·94%。血液学毒性:后超组0级61·29%,1级32·25%,2级6·45%,放化组0级38·23%,1级26·47%,2级29·41%,3级5·88%组,二组治疗失败的主要原因均为局部复发、未控和远处转移。结论:食道癌后程加速放疗和同步放化疗的1年生存率结果相当,3年生存率后程加速组高于同步放化组,但无统计学差异,后程加速组的2、3级食道反应多于放化组,而同步放化疗的血液学毒性高于后程加速放疗组。
OBJECTIVE: To compare the efficacy and toxicity of hyperfractionated radiotherapy and concurrent radiotherapy for esophageal cancer. Methods: Sixty-five patients in the whole group were randomly divided into a late course accelerated radiotherapy group (abbreviated as post-supergroup) and a concurrent radiochemotherapy group (abbreviated as radiochemotherapy group). In the first 4 weeks, the treatment of the two groups was the same. Cobalt-60 long-distance treatment machine was used. Conventional segmentation radiotherapy was performed at 1·9 Gy/time. Once a day, the total dose was 39·9 Gy, and the late-course acceleration group was changed to 1·5 Gy each time. Two times a day, the total irradiation dose was 63. 9 ~ 66 · 9Gy. The conventional radiotherapy and chemotherapy group divided radiotherapy routinely, the total radiation dose was 62·7~66·5Gy, and the fourth week of radiotherapy plus FP chemotherapy: DDP 20mg/m2. Intravenously, on the first 4 days, 5-FU 500mg/m2, the first 1 to 4 days. One month after the end of treatment, the appetite meal was evaluated for short-term efficacy. Results: One case was lost in all cases, and the follow-up rate was 98%. The median follow-up time was 22 months (February to 42 months) in the supergroup and 21 months (April to 48 months) in the radiochemotherapy group. The 1-year and 3-year survival rates of the supergroup and radiochemotherapy group were 74.87. %, 75% and 43.5%, 31.87%, P>0.05, no statistically significant difference. Acute esophageal response: After the super group 0 29.03%, level 38.7%, level 2 22.58%, level 3 9.67%; radiochemistration group 0 38.23%, level 1 47.05 %, Level 2 11.76%, Level 3 2.94%. Hematological Toxicity: After the Supergroup 0 1 61.29%, Level 1 32. 25%, Level 2 6. 45%, Radiochemistration 0 Level 38. 23%, Level 1 26. 47%, Level 2 29. 41 The main reasons for the failure of treatment in both groups were local recurrence, uncontrolled, and distant metastasis in %, grade 3 5.88% groups. Conclusion: The one-year survival rate of late-course accelerated radiotherapy and concurrent radiotherapy and chemotherapy for esophageal cancer was equivalent. The three-year survival rate in the late-course accelerated group was higher than that in the synchronized radiochemotherapy group, but there was no statistical difference. The late-course accelerated group was grade 2 and 3 The esophageal response was more than that in the radiochemotherapy group, and the hematologic toxicity of concurrent radiochemotherapy was higher than that of the accelerating radiotherapy group.