Ⅲ期N (+)食管癌IMRT与3DCRT疗效比较

doi:10.3760/cma.j.issn.1004-4221.2016.05.005

摘要
图/表
参考文献()
相关文章 (15)
点击分布统计
下载分布统计

全文: PDF (448 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS) 背景资料

摘要目的观察Ⅲ期N (+)食管癌3DCRT与IMRT疗效及不良反应。方法 2003—2012年符合入组条件的食管癌患者428例,其中293例3DCRT、135例IMRT,中位剂量60 Gy。Kaplan-Meier法计算OS率等并Logrank法检验。结果 3DCRT与IMRT的1、3、5年LC率分别为65.1%、40.6%、37.5%与70.0%、57.0%、49.4(P=0.025),OS率分别为56.0%、22.3%、15.7%与53.3%、29.2%、17.8%(P=0.394)。IMRT的肺平均受量高于3DCRT的(P=0.001),肺V₂₀、V₂₅、V₃₀、V₃₅低于3DCRT (P=0.007、0.000、0.000、0.000)。IMRT的2、3级急性放射性食管炎发生率高于3DCRT的(P=0.000、0.006),2级急性放射性肺炎发生率高于3DCRT的(P=0.043)。全组共死亡343例,以局部因素为主(60.6%),其次为远处转移(25.1%)。IMRT死于肿瘤局部因素比率明显低于3DCRT (51.0%比64.5%,P=0.021)。结论 IMRT治疗食管癌是有效的,相比于3DCRT其局部控制率明显提高。但IMRT未显示出对长期OS率的提高。死因主要是局部因素,其次是远处转移。IMRT的死于局部因素比例明显低于3DCRT的。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	张安度
	韩春
	王澜
	徐珊
	朱龙玉
	孔洁
	高超
	李晓宁

关键词 ：食管肿瘤/放射疗法, 放射疗法, 三维适形, 放射疗法, 调强, 预后

Abstract： Objective To investigate the therapeutic effects and adverse effects of three-dimensional conformal radiotherapy (3DCRT) and intensity-modulated radiotherapy (IMRT) in patients with stage Ⅲ N (+) esophageal cancer. Methods A total of 428 patients with esophageal cancer who were treated from 2003 to 2012 and met the inclusion criteria were enrolled, and among these patients, 293 received 3DCRT and 135 received IMRT. The median radiation dose was 60 Gy. The Kaplan-Meier method was used to calculate survival rates and the log-rank test was used for survival difference analysis. Results The 1-, 3-, and 5-year local control rates in 3DCRT group and IMRT group were 65.1%/40.6%/37.5% and 70.0%/57.0%/49.4%, respectively (P=0.025). The 1-, 3-, and 5-year overall survival (OS) rates in 3DCRT group and IMRT group were 56.0%/22.3%/15.7% and 53.3%/29.2%/17.8%, respectively (P=0.394). Compared with the 3DCRT group, the IMRT group had a significantly higher mean lung dose (P=0.001) and significantly lower lung V₂₀, V₂₅, V₃₀, and V₃₅(P=0.007, 0.000, 0.000, and 0.000). Compared with the 3DCRT group, the IMRT group had significantly higher incidence rates of grade Ⅱ and Ⅲ acute radiation esophagitis and grade Ⅱ acute radiation pneumonitis (P=0.000, 0.006, and 0.043). Of all patients, 343 patients died, and the main cause of death was local factors (60.6%), followed by distant metastasis (25.1%). The IMRT group had a significantly lower proportion of patients who died of local factors than the 3DCRT group (51.0% vs. 64.5%, P=0.021). Conclusions IMRT is effective in the treatment of esophageal cancer, and compared with 3DCRT, it significantly improves the local control rate. However, IMRT does not improve the long-term OS rate. The main cause of death is local factors, followed by distant metastasis. The patients receiving IMRT have a significantly lower proportion of those who die of local factors than the patients receiving 3DCRT.

Key words： Esophageal neoplasms/radiotherapy Radiotherapy,three-dimensional conformal Radiotherapy,intensity-modulated Prognosis

收稿日期: 2015-03-16

通讯作者: 韩春,Email:hanchun2006@126.com

引用本文:

张安度,韩春,王澜等. Ⅲ期N (+)食管癌IMRT与3DCRT疗效比较[J]. 中华放射肿瘤学杂志, 2016, 25(5): 443-446.

Zhang Andu,Han Chun,Wang Lan et al. Therapeutic effects of intensity-modulated radiotherapy and three-dimensional conformal radiotherapy in patients with stage Ⅲ N (+) esophageal cancer:a comparative study[J]. Chinese Journal of Radiation Oncology, 2016, 25(5): 443-446.

链接本文:

http://journal12.magtechjournal.com/Jweb_fszlx/CN/10.3760/cma.j.issn.1004-4221.2016.05.005 或 http://journal12.magtechjournal.com/Jweb_fszlx/CN/Y2016/V25/I5/443

[1]中国非手术治疗食管癌临床分期专家小组.非手术治疗食管癌的临床分期标准(草案)[J].中华放射肿瘤学杂志,2010,19(3):179-180.DOI:10.3760/cma.j.issn.1004-4221.2010.03.001.China non operative treatment of esophageal cancer clinical staging expert group. Standard for clinical staging of non operative treatment for esophageal cancer (Draft)[J].Chin J Radiat Oncol,2010,19(3):179-180.DOI:10.3760/cma.j.issn.1004-4221.2010.03.001.
[2]韩春,王澜,祝淑钗,等.非手术治疗食管癌临床分期标准对225例放疗患者的预后评价[J].中华放射肿瘤学杂志,2011,20(2):109-112.DOI:10.3760/cma.j.issn.1004-4221.　2011.02.008.
Han C,Wang L,Zhu SC,et al. Evaluation of prognosis of clinical staging for esophageal carcinoma treated with non-surgical methods-addition with analysis of 225 patients[J].Chin J Radiat Oncol,2011,20(2):109-112.DOI:10.3760/cma.j.issn.1004-4221.2011.02.008.
[3]van Overhagen H,Laméris JS,Berger MY,et al. Supraclavicular lymph node metastases in carcinoma of the esophagus and gastroesophageal junction:assessment with CT,US and US-guided fine-needle aspiration biopsy[J].Radiology,1991,179(1):155-158.DOI:10.1148/radiology.179.1.2006268.
[4]王澜,高超,李晓宁,等.100例食管癌三维适形放疗疗效分析[J].中华放射肿瘤学杂志,2009,18(5):375-378.DOI:10.3760/cma.j.issn.1004-4221.2009.05.375.
Wang L,Gao C,Li XN,et al. Treatment outcomes of three-dimensional conformal radiotherapy for esophageal carcinoma[J].Chin J Radiat Oncol,2009,18(5):375-378.DOI:10.3760/cma.j.issn.1004-4221.2009.05.375.
[5]杨红茹,刘文其,廖锡宏,等.食管癌常规放疗与三维适形放疗的临床研究[J].中国肿瘤杂志,2010,19(2):143-147.
Yang HR,Liu WQ,Liao XH,et al. Clinical study on conventional radiotherapy and three-dimensional conformal radiotherapy for esophageal cancer[J].China Cancer,2010,19(2):143-147.
[6]李任,祝淑钗,沈文斌,等.170例食管癌患者放射治疗疗效分析[J].中国肿瘤临床,2007,34(19):1112-1116.DOI:10.3969/j.issn.1000-8179.2007.19.009.
Li R,Zhu SC,Shen WB,et al. Effects of different radiotherapy techniques on 170 cases with esophageal carcinoma[J].Chin J Clin Oncol,2007,34(19):1112-1116.DOI:10.3969/j.issn.1000-8179.2007.19.009.
[7]王玉祥,王军,祝淑钗,等.老年食管癌三维适形与调强放射治疗疗效比较[J].肿瘤防治研究,2012,39(8):1008-1013.DOI:10.3971/j.issn.1000-8578.2012.08.031.
Wang YX,Wang J,Zhu SC,et al. Comparison of prognosis on esopageal carcinoma treated with 3DCRT and imrt for elderly patients[J].Cancer Res Prev Treat,2012,39(8):1008-1013.DOI:10.3971/j.issn.1000-8578.2012.08.031.
[8]程岩,王丽梅,张雪彬,等.食管癌调强放疗疗效和预后因素分析[J].疾病监测与控制,2013,7(8):505-506.
Cheng Y,Wang LM,Zhang XB,et al. Analysis of curative effect and prognostic factors of esophageal cancer with intensity modulated radiation therapy[J].J Dis Mon Cont,2013,7(8):505-506.