胸段食管癌三维适形放疗临床靶体积前瞻性随机临床研究

A Prospectively Randomized Study of Clinical Target Volume Margins for Three-dimensional Conformal Radiotherapy in Patients with Thoracic Esophageal Squamous Cell Carcinoma

    摘要
  • 摘要:
      目的   前瞻性研究不同临床靶体积对胸段食管癌三维适形放射治疗疗效的影响，探讨食管癌三维适形放疗的临床靶区范围。
      方法   2006年5月至2009年9月收治的94例食管鳞癌患者随机分为累及野组和扩大野组，均接受三维适形放疗。累及野组49例，CTV包括原发灶上下外扩3cm、周围外扩0.8cm及肿大淋巴结累及区；扩大野组45例，食管癌原发灶CTV外扩同累及野组，但需根据原发灶部位不同，给予区域淋巴结引流区的预防照射。
      结果   全组患者1、3年生存率分别为67.7%、35.7%。中位生存期为24.6个月。累及野组和扩大野组1、3年的生存率分别为66.9%、36.2%和68.6%、35.5%（P=0.961），局部控制率分别为72.4%、54.5%和69.5%、46.0%（P=0.640），无瘤生存率分别为63.8%、43.7%和64.8%、40.6%（P=0.887）。累及野组Ⅱ级以上放射性食管炎为32.7%，扩大野组为42.2%（P=0.338）。两组急性放射性肺炎的发生率分别为30.6%和35.6%（P=0.464）。
      结论   扩大野组在生存率、局部控制率、无瘤生存率方面未表现出优势，两组疗效相当。扩大野组放射性食管炎及放射性肺炎的发生率均高于累及野组，但两组比较无统计学差异。

     

    Abstract:
      Objective   To observe prospectively the effect of different clinical target volumes (CTVs) on the prognosis of patients with thoracic esophageal squamous cell carcinoma (TESCC), and determine the optional CTV margins for three-dimensional conformal radiotherapy (3DCRT).
      Methods   A total of 94 patients with TESCC between May 2006 and November 2009 were randomized into two groups, namely, elective nodal irradiation (elective) and involved nodal irradiation (involved) groups. All patients received 3DCRT. For the 49 patients of the involved group, the CTV was defined as the GTV plus a 3 cm margin superior and inferior to the primary tumor and a 0.8-1.0 cm radial margin. In the elective group, based on the different locations of the primary tumor, the adjacent regional lymphatics was included in the CTV in addition to the same margins outside the primary tumor as those in the involved nodal irradiation group.
      Results   For both groups, the one- and three-year survival rates were 67.7% and 35.7%, respectively. The median survival was 24.6 months. The one- and three-year survival rates were 66.9% and 36.2% in the involved group, as well as 68.6% and 35.5% in the elective group, respectively (P = 0.961). The one- and three-year locoregional control rates were 72.4% and 54.5%, as well as 69.5% and 46.0% in the involved and elective groups, respectively (P = 0.640). The one- and three-year progression-free survival rates were 63.8% and 43.7%, as well as 64.8 % and 40.6% in the two groups, respectively (P = 0.887). The grade II and higher radiation esophagitis rates were 32.7% and 42.2%, respectively (P = 0.338). The symptomatic radiation pneumonitis rates were 30.6% and 35.6%, respectively, in the two groups (P = 0.464).
      Conclusion   Conformal radiotherapy with elective nodal irradiation for TESCC showed no significant advantage over conformal radiotherapy with involved nodal irradiation in terms of the overall survival, locoregional control, and progression-free survival. Conformal radiotherapy with elective nodal irradiation conferred higher radiation esophagitis and pneumonitis. The main reason of failure was local failure.

     

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