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目的：探讨高剂量率腔内近距离放疗配合外放射治疗食管癌的价值。方法：1990年3月至1993年6月随机分组对照研究了185例食管癌。对照组80例，内外结合组（治疗组）105例。对照组用直线加速器常规外照射60～70Gy。治疗组在外照射58～60Gy后1～2周加内照射2～3次，每次5～8Gy，间隔5～7天。腔内照射剂量范围为外照射前病灶上下端延长1cm。结果：1）对照组和治疗组1、3、5年生存率分别为40．2％、26．25％、12．50％和62．25％、32．38％、19．05％。两组间1年生存率有显著的差异P＜0．05，3、5年生存率差异不显著。2）治疗组中病灶＜7cm和≥7cm两者的1、3、5年生存率中仅1年生存率有显著差异，3、5年生存率无显著差异。3）把治疗组按初诊时有无胸、背痛分类，发现1年生存率有显著差异，3、5年生存率差异不显著。4）从治疗组治疗后复查食管钡餐发现，病灶＜7cm患者中钡餐改变明显与不明显的1年生存率有显著差异P＜0．05，3、5年生存率差异不明显。病灶≥7cm患者中钡餐改变明显与否的1、3、5年生存率均无明显差异。结论：高剂量率腔内近距离放疗配合外照射治疗食管癌可改善进食，提高1年生存率。对3、5年生存率的影响尚待进一步观察。治疗后食管炎发生率明显增加71．4％，放疗后的食管损伤是影响
Objective: To investigate the value of high dose rate intraluminal brachytherapy combined with external radiation therapy for esophageal cancer. Methods: A total of 185 cases of esophageal cancer were randomly divided into groups from March 1990 to June 1993. There were 80 cases in the control group and 105 cases in the internal and external combined group (treatment group). The control group received 60-70 Gy of conventional external irradiation with a linear accelerator. The treatment group received internal irradiation for 2 to 3 times each at 1 to 2 weeks after external irradiation of 58 to 60 Gy, each time at 5 to 8 Gy, with an interval of 5 to 7 days. The range of irradiation dose in the cavity was 1 cm above and below the lesion before and after the external irradiation. Results: 1) The 1-, 3- and 5-year survival rates in the control and treatment groups were 40.2%, 26.25%, 12.50% and 62.25%, 32.38%, and 19.05%, respectively. There was a significant difference in 1-year survival rate between the two groups (P<0.05), and there was no significant difference between the 3-year and 5-year survival rates. 2) In the treatment group, the 1-, 3-, and 5-year survival rates of the lesions <7cm and ≥7cm were significantly different from those of the 1-year survival rate. There was no significant difference between the 3 and 5-year survival rates. 3) The treatment group was classified according to whether or not there was chest and back pain at the time of initial diagnosis. It was found that there was a significant difference in the 1-year survival rate and there was no significant difference in the 3-year and 5-year survival rates. 4) After reviewing the esophageal barium meal after treatment, there was a significant difference between the barium meal changes and the unobvious 1-year survival rate in patients with lesions <7 cm (P<0.05). There was no significant difference between the 3 and 5 year survival rates. There was no significant difference in the 1-, 3-, and 5-year survival rates of patients with lesions ≥ 7cm with or without obvious change in barium meal. CONCLUSIONS: High-dose-rate intraluminal brachytherapy combined with external irradiation for esophageal cancer can improve food intake and increase 1-year survival. The impact on the 3-year and 5-year survival rates remains to be further observed. The incidence of esophagitis after treatment was significantly increased by 71.4%. Esophageal injury after radiotherapy was an effect.