目的探讨不同临床靶体积范围对食管癌三维适形放射治疗结果的影响。方法选取2011年6月—2014年6月洛阳中心医院收治的食管癌患者120例为研究对象,均择期行根治性三维适形放疗(3D-CRT)/调强放疗(IMRT),根据临床靶区(CTV)范围不同将其分为累及野组(CTV包括原发灶上下外扩3 cm、周围外扩0.8~1.0 cm及肿大淋巴结累及区)和扩大野组(CTV包括原发病灶上下外扩3 cm、周围外扩0.8~1.0 cm及相应淋巴结引流区),每组60例。计划靶体积(PTV)的处方剂量为60 g/30次·6周,记录两组放疗后6个月、12个月局控率、生存率及远处转移失败率,同时分析双肺接收大于10、20、30 Gy剂量照射的肺体积百分比[V10(%)、V20(%)、V30(%)],并比较不良反应。结果累及野组放疗后6个月局控率、生存率、远处转移失败率分别为83.33%、76.67%、41.67%,放疗后12个月分别为80.00%、71.67%、46.67%;扩大野组放疗后6个月分别为85.00%、78.33%、45.00%,放疗后12个月分别为81.67%、75.00%、48.33%,与累及野组比较差异无统计学意义(P均>0.05)。扩大野组双肺V10为(48.92±10.71)%、V20为(27.35±3.54)%、V30为(15.21±1.78)%,累及野组分别为(41.33±9.67)%、(21.53±3.62)%、(11.37±1.54)%,两组比较差异均有统计学意义(P均<0.05)。扩大野组不良反应发生率为13.3%,累及野组为3.3%,差异有统计学意义(P<0.05)。结论累及野组在食管癌三维适形放疗中局控率、生存率、远处转移率与扩大野组差异无统计学意义,但不良反应及放射性肺炎发生率低于扩大野组,食管癌晚期选择性行累及野放疗是安全的。 Objective To investigate the influence of different clinical target volume range on the results of three-dimensional conformal radiotherapy for esophageal cancer. Methods 120 patients with esophageal cancer admitted from June 2011 to June 2014 in Luoyang Central Hospital were enrolled. All patients underwent elective three-dimensional conformal radiotherapy (3D-CRT) (CTV) ranged from 3 to 6 years old. The CTV ranged from 3 cm up and down, 0.8 cm up to 1.0 cm around the primary tumor, and enlarged lymph node involvement in the CTV. External expansion 3 cm, around the external expansion 0.8 ~ 1.0 cm and the corresponding lymph node drainage area), 60 cases in each group. The planned dose of target volume (PTV) was prescribed at 60 g / 30 times for 6 weeks. The two groups were recorded at 6 months and 12 months after radiotherapy. The control rate, survival rate and distant metastasis failure rate were recorded. V2O (%), V20 (%), V30 (%)] at 10, 20 and 30 Gy doses were compared and adverse reactions were compared. Results The local control rate, survival rate and distant metastasis failure rate of the wild group were 83.33%, 76.67% and 41.67% respectively at 6 months after radiotherapy, and were 80.00%, 71.67% and 46.67% respectively at 12 months after radiotherapy. The radiotherapy group was 85.00%, 78.33% and 45.00% respectively at 6 months after radiotherapy, and 81.67%, 75.00% and 48.33% respectively at 12 months after radiotherapy. There was no significant difference between the two groups (P> 0.05). V10 was (27.35 ± 3.54)%, V30 was (15.21 ± 1.78)% in the enlarged group, and (41.33 ± 9.67)% and (21.53 ± 3.62)% in the involved group were (48.92 ± 10.71) , (11.37 ± 1.54)% respectively. There was significant difference between the two groups (all P <0.05). The incidence of adverse reactions in the enlarged group was 13.3%, and that in the wild group was 3.3%, the difference was statistically significant (P <0.05). Conclusion There is no significant difference in the control rate, survival rate, distant metastasis rate and enlarged field between the three groups in esophageal cancer patients with esophagectomy and esophageal cancer. However, the incidence of adverse reactions and radiation pneumonitis is lower than that in the esophageal cancer group and esophageal cancer patients It is safe to choose a line and field radiotherapy.