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目的 对近年国内报道的食管癌非常规分次方案进行剂量—效应分析 ,探索改善放射治疗疗效较合理的方案。方法 收集 1989年以来食管癌非常规分次 (ICF)照射和以常规剂量分次(CF)作为对照的前瞻性随机分组结果 ,比较肿瘤局部控制率或 (及 )生存率。依LQ模式计算各个方案对肿瘤组织的放射生物学效应剂量 (BEDT)值 ,与各自的CF对照组进行剂量—效应比较。结果 超分割 (HF) 3个组中有 2个组疗效显著提高 ,其BEDT 值分别高出 5 + 、10Gy ;疗效无差异 1个组BEDT值降低 6 .8Gy。加速超分割 (AHF) 2个组中 1个组BEDT 值降低 17.2Gy,疗效无差异 ;1个组疗效显著提高不能用BEDT 值降低 11.3Gy来解释。后程加速超分割 (LAHF)的 7个组中 ,疗效显著提高的有 6个组 ,其BEDT 值比较不能用于预测LAHF对CF方案的疗效差别。后程加速分割 (LAF) 1个组BEDT值仅高出 2 .8Gy,但 1、3年生存率提高非常显著。前程加速分割 (EAF) 1个组的已知疗终完全缓解率提高的相关因素是剂量高出 6 .8Gy。结论 (1)用ICF方案有可能在肿瘤局部控制率、生存率方面显著高于CF6 0～ 70Gy,6～ 7周方案者。 (2 )AHF、LAHF和LAF的疗效显著提高不能用该方案的BEDT 值来解释和预测 ,疗效的显著改善不依赖于剂量的增加。 (3)照射后使肿瘤细胞集群对放射
Objective To analyze the dose-response of unconventional grades of esophageal cancer reported in China in recent years, and to explore ways to improve the efficacy of radiation therapy. METHODS: Randomized prospective randomized groupings of uncontrolled esophageal cancer (ICF) irradiation and conventional dose fractionation (CF) since 1989 were performed to compare local tumor control rates or (and) survival rates. The radiobiological effect dose (BEDT) values of the tumor tissues were calculated according to the LQ model and compared with the respective CF control group. RESULTS: In the hyperfractionated (HF) group, there was a significant increase in efficacy in 2 of the 3 groups. The BEDT values were 5 + and 10 Gy, respectively; there was no difference in efficacy. The BEDT value of the 1 group decreased by 6.8 Gy. Accelerated hyperfractionation (AHF) reduced the BEDT value of 17.2Gy in 1 of the 2 groups with no difference in efficacy; a significant increase in efficacy in 1 group could not be explained by a 11.3Gy decrease in BEDT value. In the seven groups with late-acting accelerated hyperfractionation (LAHF), there were six groups with significantly improved efficacy. The comparison of BEDT values could not be used to predict the difference in efficacy of LAHF on CF regimens. In the LAF group, the BEDT value was only 2.8 Gy higher, but the 1- and 3-year survival rates increased significantly. The related factor for the improvement of the final complete response rate of the end-effect accelerated segmentation (EAF) group 1 is 6.8 Gy higher. Conclusions (1) The ICF regimen may be significantly higher than the CF6 0-70Gy in the local control rate and survival rate of the tumor and the 6-7-week planners. (2) The significant improvement in the efficacy of AHF, LAHF, and LAF cannot be explained and predicted by the BEDT value of this regimen. The significant improvement in efficacy is independent of dose increase. (3) Cluster of tumor cells after irradiation to radiation