胸段食管癌伴纵隔淋巴结转移调强放疗疗效分析

陶华; 陆进成; 陆昕

doi:10.3969/j.issn.1000-8179.2012.18.010

胸段食管癌伴纵隔淋巴结转移调强放疗疗效分析

Efficacy of Intensity-Modulated Radiotherapy with or without Concurrent Chemotherapy for Thoracic Esophageal Carcinoma with Mediastinal Lymph Node Metastasis

摘要

摘要:
目的比较并分析调强放疗伴或不伴同步化疗治疗胸段食管癌伴纵隔淋巴结转移的结果。
方法回顾性分析江苏省肿瘤医院放疗科2007年1月至2008年1月共49例接受调强放疗的食管癌患者, 均经胃镜病理证实且胸部CT示纵隔淋巴结肿大。17例接受单纯调强放射治疗(单放调强组), 32例接受调强放疗同步FP方案化疗治疗(同步放化组)。同步化疗方案为复方氟尿嘧啶80 mg/m², d1~5, 奈达铂70 mg/m², d1。放疗从化疗第1天开始, 单放调强组方案为6MV-X线IMRT放疗GTV 60~70 Gy, CTV 54~63 Gy, 同步放化组方案为6MV-X线IMRT放疗GTV 60 Gy, CTV 54 Gy。分次剂量为GTV 2.0 Gy/次, CTV 1.8 Gy/次。6~7周完成。
结果全组患者均顺利完成治疗计划, 不良反应小, 中位随访时间为34个月, 随访率为97%单放调强组与同步放化组1、2、3年局控率分别为93.3%、60.9%、25.4%和90.3%、78.7%、58.1%(χ²=3.198, P=0.074), 1、2、3年生存率分别为88.2%、44.1%、29.4%和93.5%、71.1%、55.9%(χ²=4.733, P=0.030)。两组不良反应主要为急性放射性食管炎, 调强放疗同步化疗组骨髓抑制发生率较单纯调强放疗组高, 经对症处理后, 两组患者均顺利完成治疗计划, 无一例因不良反应终止或延长治疗时间。
结论调强放疗同步化疗组较单纯调强放疗组能提高伴纵隔淋巴结转移的胸段食管癌患者生存率，不良反应能耐受。

Abstract:
Objective To compare the therapeutic efficacy of intensity-modulated radiotherapy (IMRT) with or without concurrent chemotherapy for thoracic esophageal carcinoma with mediastinal lymph node metastasis.
Methods AData of 49 patients with thoracic esophageal carcinoma confirmed by endoscopic biopsy between January 2007 and January 2008 were retrospectively reviewed in this study. All cases were pathologically verified to be squamous carcinoma and were found to suffer mediastinal lymph node metastasis by computerized tomography. Seventeen patients underwent simple IMRT (IMRT group), whereas concurrent chemotherapy was added to the treatment of the remaining 32 patients (CRT group). The chemotherapy regimen was 80 mg/m² Co-fluorouracil on days 1 to 5 and 70 mg/m² Cis-Diammine- Glycoplatinum on day 1. Radiation dose was prescribed as Gross Tumor Volume (GTV) 60 Gy to 70 Gy and Clinical Target Volume (CTV) 54 Gy to 63 Gy for the IMRT group, and GTV 60 Gy and CTV 54 Gy for the CRT group. A dose of 2 Gy / fraction was given for GTV and 1.8 Gy / fraction for CTV. The whole course of treatment lasted for six to seven weeks. Radiotherapy started on the first day of chemotherapy.
Results All cases complied well with the assigned therapy without interruption. The toxicity response was tolerated. The median follow-up time was 34 months and the follow-up rate was 97 %. The 1-, 2-, and 3-year local control rate was 93.3 %, 60.9 %, and 25.4 % in the IMRT group, and 90.3 %, 78.7 %, and 58.1 % in the CRT group (χ²= 3.198, P = 0.074), respectively. The 1-, 2-, and 3-year survival rate was 88.2 %, 44.1 %, and 29.4 % for the IMRT group, and 93.5%, 71.1%, and 55.9% for the CRT group (χ² = 4.733, P = 0.030), respectively. The toxicity related to the therapy was acute radiated esophageal injury. The bone marrow inhibition rate of CRT was higher in the CRT group compared with that of the IMRT group. All patients received treatment plans for appropriate symptomatic thetreatments was ceased or prolonged because of toxicity in the cases.
Conclusion IMRT with concurrent chemotherapy might be superior to simple IMRT in terms of the 1-, 2-, and 3-year survival rate for thoracic esophageal carcinoma patients with mediastinal lymph node metastasis. The toxicity could be well tolerated.

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