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目的 评价胸上、中段食管鳞癌后程加速超分割放射治疗的疗效。方法 82例胸上、中段食管鳞癌病例随机分为后程加速超分割 (后加速组 )和常规分割 (常规组 )两组。常规组总剂量 6 4～ 6 6Gy ,6 .5周完成。后加速组为前 3周采用常规分割 ,后 2周采用超分割方法 ,即 1.5Gy/次 ,2次 /d ,间隔 6h ,总剂量 6 0Gy ,5周完成。结果 2个组近期疗效比较无差别。后加速组 1、2、3、4年局部控制率分别为 6 8.3%、4 5 .0 %、4 5 .0 %、4 5 .0 % ,常规组分别为 5 2 .6 %、30 .1%、2 7.4 %、2 2 .8% ,2个组差异无显著性意义 (χ2 =3.0 1,P =0 .0 8)。后加速组 1、2、3、4年生存率分别为 73.2 %、4 2 .2 %、39 .4 %、31.3% ,常规组分别为 6 1.0 %、31.7%、2 6 .8%、19.6 % ,2个组差异无显著性意义 (χ2 =1.4 6 ,P=0 .2 2 )。后加速组中位复发时间为 11个月 ,常规组为 9个月 ,二者无差别 (P >0 .0 5 )。后加速组放射性食管炎发生率较常规组高 (P <0 .0 1) ,食欲下降发生率亦较常规组高 (P <0 .0 5 ) ,无中断病例。 2个组病例共死亡 5 9例 ,肿瘤复发和未控仍然是主要死亡原因。后加速组死亡 2 7例 ,除 4例远地转移和 1例非癌死亡外 ,其他 2 2例均和局部复发有关 ;常规组死亡 32例 ,除 2例远地转移外均和局部复发有关。?
Objective To evaluate the effect of late course accelerated hyperfractionation radiotherapy on the upper and middle esophageal squamous cell carcinoma. Methods A total of 82 cases of upper and middle esophageal squamous cell carcinoma were randomly divided into two groups: accelerated accelerated hyperfractionation (post-acceleration group) and conventional segmentation (conventional group). The conventional group total dose of 6 4 ~ 6 6Gy, 6.5 weeks to complete. The post-acceleration group was divided into the first 3 weeks and the second 2 weeks with the super-segmentation method, 1.5 Gy / time, 2 times / d, 6h intervals, the total dose of 60 Gy, 5 weeks to complete. Results The two groups no difference in the short term efficacy. The local control rates in the post-acceleration group at 1, 2, 3 and 4 years were 6 8.3%, 45.0%, 45.0% and 45.0% respectively, compared with 52.6% and 30.5% respectively in the conventional group. 1%, 2 7.4% and 22.8% respectively. There was no significant difference between the two groups (χ2 = 3.01, P = 0.08). The 1-year, 2-year, 3-year and 4-year survival rates of the post-acceleration group were 73.2%, 42.2%, 39.4% and 31.3% respectively, compared with 6 1.0%, 31.7%, 26.8% and 19.6% %, No significant difference between the two groups (χ2 = 1.4 6, P = 0.22). The post-acceleration group had a median time to recurrence of 11 months compared with 9 months in the conventional group, with no difference between the two groups (P> 0.05). The incidence of radiation esophagitis in the post-acceleration group was higher than that in the conventional group (P <0.01), and the incidence of appetite decline was also higher than that in the conventional group (P <0.05). A total of 59 deaths occurred in two groups. The recurrence and non-control of the tumors were still the major causes of death. In the post-acceleration group, 27 cases died, except 4 cases of distant metastasis and 1 case of non-cancerous death, the other 22 cases were related to local recurrence. In the routine group, 32 cases died, except for 2 cases of distant metastasis, all were related to local recurrence . ?