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目的观察一定剂量的外照射后不同时期加腔内放射治疗的疗效及副作用,以探讨较适当的腔内照射时机。方法100例食管癌患者随机分2组,A组35Gy外照射后,即开始内外照射同期进行。B组50Gy外照射后开始腔内照射。两组外照射总吸收剂量均为50Gy,采用常规分割照射,1.8～2Gy/次,5次/周。腔内照射5Gy/次,每周1次,共2次。结果A组的1、3和5年局控率分别为60.2%、39.8%和36.2%,B组的1、3和5年局控率分别为54.1%、32.8%和29.2%;P=0.5118。两组的1、3和5年生存率分别为52.0%、26.0%、21.8%和54.0%、23.4%、16.7%,P=0.8159。A组和B组急性放射性食管炎的发生率分别为70%(35/50)和48%(24/50),P=0.038,但严重的食管炎(Ⅲ级及以上)的发生率相当,均为4%。A组和B组食管瘘的发生率分别为8%(4/50)和10%(5/50)。结论于35Gy外照射后同期加腔内照射及外照射50Gy结束后即局部补加腔内照射均是可行的。两种治疗方案相比,前者急性放射性食管炎的发生率高于后者,但晚期并发症无增加。
Objective To observe the curative effect and side effects of intracavitary radiotherapy in different periods after a certain dose of external irradiation to explore the more appropriate timing of intraluminal irradiation. Methods 100 cases of esophageal cancer patients were randomly divided into two groups, A group of 35Gy external irradiation, that is, internal and external exposure began simultaneously. Group B 50Gy after irradiation began intracavitary irradiation. The total absorbed dose of two groups of external radiation were 50 Gy, using conventional split irradiation, 1.8 ~ 2Gy / time, 5 times / week. Endometrial irradiation 5Gy / time, once a week, a total of 2 times. Results The 1, 3 and 5 year local control rates in group A were 60.2%, 39.8% and 36.2%, respectively. The 1,3 and 5 year local control rates in group B were 54.1%, 32.8% and 29.2%, respectively; P = 0.5118 . The 1-, 3-, and 5-year survival rates of the two groups were 52.0%, 26.0%, 21.8% and 54.0%, 23.4% and 16.7%, respectively, P = 0.8159. The incidence of acute esophagitis in group A and group B was 70% (35/50) and 48% (24/50), respectively, P = 0.038, but the incidence of severe esophagitis (grade III and above) All 4%. The incidence of esophageal fistulas in Groups A and B was 8% (4/50) and 10% (5/50), respectively. Conclusions 35Gy external irradiation after the same period plus intracavitary irradiation and external irradiation after the end of 50Gy local additional intracavitary irradiation are feasible. The two treatment options, the former the incidence of acute radiation esophagitis was higher than the latter, but no increase in late complications.