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目的 分析影响食管癌后程加速超分割放射治疗疗效的因素及失败原因。方法 回顾分析本院后程加速超分割放射治疗食管癌 2 0 1例 ,放射治疗方法均为前 2 / 3病程常规放射治疗 1.8Gy/次 ,共 41.4Gy左右 ,后 1/ 3疗程缩野改为加速超分割放射治疗 (2次 /d ,1.5Gy/次 ) ,共 2 7Gy左右 ,全疗程总剂量共 6 7～ 70Gy ,40～ 43分次 ,40～ 49d完成。结果 随访时间 4～ 6 9个月 (中位 2 8个月 ) ,随访率为 92 %。 1、3、5年生存率分别为 72 .5 %、35 .6 %、31.1% ,中位生存时间为 2 4.0个月。 1、3、5年局部控制率分别为 82 .2 %、71.3%和 71.3%。在 2 0 1例病例中 ,已死亡病例 95例。其中死于局部失败 34例占死亡病例的 35 .8% ;远地转移 32例占 33.7% ;局部失败 +远地转移 4例占 4.2 % ;淋巴结转移 13例占 13 .7% ;食管出血、穿孔和放射性肺炎 12例占 12 .7%。结论 后程加速超分割放射治疗疗效较常规分割治疗的历史水平明显提高 ,如何预防和治疗远地转移和淋巴结转移是进一步提高食管癌放射治疗疗效的重要课题
Objective To analyze the factors affecting the efficacy of hyperfractionated radiotherapy for delayed esophageal cancer and the causes of failure. Methods A retrospective analysis of our hospital’s late course accelerated hyperfractionated radiotherapy for esophageal cancer was performed in 201 cases. The radiation therapy methods were conventional radiation therapy 1.8Gy/time for the previous 2 / 3 times, with a total of 41.4Gy, and after 1 / 3 courses shrinking wild In order to accelerate hyperfractionated radiation therapy (2 times/d, 1.5Gy/times), a total of about 2 7Gy, the total dose of the whole course of treatment was 6 7 ~ 70Gy, 40 ~ 43 minutes, and 40 ~ 49d. Results The follow-up time was 4 to 69 months (median 28 months). The follow-up rate was 92%. The 1-, 3-, and 5-year survival rates were 72.5%, 35.6%, and 31.1%, respectively, and the median survival time was 2 4.0 months. The local control rates for 1, 3, and 5 years were 82.2%, 71.3%, and 71.3%, respectively. Among the 201 cases, 95 have died. Among them, 34 patients who died of local failure accounted for 35.8% of the deaths; 32 patients accounted for 33.7% of distant metastases; 4 patients accounted for local failures and distant metastases accounted for 4.2%; 13 patients had lymph node metastasis, accounting for 13.7%; esophageal hemorrhage, Perforation and radiation pneumonitis accounted for 12.7% of 12 cases. Conclusion The curative effect of late-course accelerated hyperfractionated radiotherapy is significantly higher than that of conventional segmentation therapy. How to prevent and treat distant metastasis and lymph node metastasis is an important issue to further improve the efficacy of radiotherapy for esophageal cancer.