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目的 探讨不均等剂量放射治疗食管癌的可行性。方法 16 0例食管鳞癌患者 ,信封法随机分为不均等剂量组 80例 ,常规剂量组 80例。入组者需无明显食管龛影及穿孔征象。两组均采用模拟机定位 ,体外 3个野照射。不均等剂量组 4Gy/次 ,5d/周 ,第 2周开始 2Gy/次 ,5d/周 ,共 70Gy 6周。常规剂量组 2Gy/次 ,5d/周 ,共 70Gy 7周。结果 全部病例随访 5年以上。局部控制率不均等剂量组和常规剂量组分别为 46 .3 %、2 7.5 % (χ2 =6 .15 0 ,P =0 .0 2 2 )。 1、3、5年生存率不均等剂量组分别为 72 .5 %、38.8%、31.3% ,常规剂量组分别为 5 7.5 %、2 3 .8%、16 .3% (χ2 =4.187,P =0 .0 43 ;χ2=5 .141,P =0 .0 37;χ2 =5 .45 2 ,P =0 .0 32 )。晚期放射损伤 (肺纤维化、食管狭窄、食管溃疡 )发生率低 ,两组无明显差异。结论 前程加大放射治疗剂量 ,短时间内大量杀灭肿瘤敏感细胞 ,提高了局部控制率和远期生存率 ,并且不增加副反应。不均等剂量放射治疗食管癌优于常规剂量 ,是目前可行的一种新的放射治疗方法
Objective To investigate the feasibility of inequality equal dose radiation therapy for esophageal cancer. Methods One hundred and six patients with esophageal squamous cell carcinoma were randomly divided into 80 unequal dose groups and 80 conventional dose groups. The enrollees must have no evidence of esophageal fistula and perforation. Both groups were modeled using a simulator, and three fields were irradiated in vitro. Inhomogeneous dose group 4Gy / times, 5d / week, 2Gy / 2nd week, 5d / week, a total of 70Gy 6 weeks. Conventional dose group 2Gy / times, 5d / week, a total of 70Gy 7 weeks. Results All patients were followed up for more than 5 years. The local control rate in the unequal dose group and the conventional dose group was 46.3% and 27.5%, respectively (χ2=6.15 0, P=0.02). The 1-, 3-, and 5-year survival rates in the unequal dose groups were 72.5%, 38.8%, and 31.3%, respectively; the conventional dose groups were 57.5, 23.8%, and 16.3%, respectively (χ2=4.187, P). =0.0 43; χ2=5 .141, P =0. 0 37; χ 2 =5 .45 2 ,P =0.0 32 ). Late radiation injury (lung fibrosis, esophageal stenosis, esophageal ulcer) occurred at a low rate, with no significant difference between the two groups. Conclusions In the future, the dose of radiotherapy is increased to kill a large number of tumor-sensitive cells in a short time, and the local control rate and long-term survival rate are improved, and no side effects are increased. Irregular dose radiation therapy for esophageal cancer is superior to conventional ones and is currently a viable new radiation therapy method.