T<sub>4</sub>N (+)Ⅲ期食管胸中下段癌3DRT长期生存分析

doi:10.3760/cma.j.issn.1004-4221.2017.01.006

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 (841 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS) 背景资料

摘要

目的观察T₄N (+)Ⅲ期食管胸中下段癌IMRT长期生存情况及不良反应。方法 2004—2010年间300例T₄N (+)Ⅲ期食管中下段癌患者采用3DCRT 202例、IMRT 98例,常规分割照射剂量60 Gy。比较两种不同治疗方式的长期生存情况及不良反应。Kaplan Meier法计算生存率并Logrank法检验。结果 5、7年样本量分别为239、120例。3DCRT和IMRT组1、3、5、7年LC率分别为64.4%、40.6%、38.3%、34.2%和68.3%、55.3%、51.9%、51.9%(P=0.048),OS率分别为54.5%、19.8%、14.7%、10.9%和63.3%、34.7%、24.4%、20.3%(P=0.013)。分层分析显示年龄>65岁、放疗前食管造影长度>8.0 cm、CT最大横径>4.6 cm、GTV>60 cm³、邻近组织或器官受累、非手术 N₂期、未行化疗者,IMRT组OS率高于3DCRT组(P=0.022、0.003、0.022、0.034、0.016、0.044、0.047)。IMRT组GTVD_min、GTVD₁₀₀高于3DCRT组(P=0.000、0.000),脊髓D_max低于3DCRT组(P=0.000)。IMRT组急性放射性食管炎发生率明显高于3DCRT组,以轻度(1—2级)食管炎为著(P=0.000)。3DCRT组死于肿瘤局部因素的比率明显高于IMRT组(P=0.039)。结论局部晚期食管胸中下段癌IMRT安全有效,LC率明显提高,正常组织保护良好,长期生存获益显著。基于回顾分析结果还有待前瞻性随机对照研究的证实。

	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
	任雪姣
	王澜
	韩春
	田华
	刘丽虹
	李晓宁
	高超

关键词 ：食管肿瘤/放射疗法, 放射疗法,三维, 放射疗法,调强, 预后

Abstract：

Objective To observe the long-term survival and adverse reactions in patients with stage T₄N (+) Ⅲ middle and lower thoracic esophageal carcinoma undergoing intensity-modulated radiotherapy (IMRT). Methods From 2004 to 2010, 300 patients with stage T₄N (+) Ⅲ middle and lower thoracic esophageal carcinoma, consisting of 202 treated with three-dimensional conformal radiotherapy (3DCRT) and 98 treated with IMRT, were enrolled as subjects. All patients received conventionally fractionated radiotherapy with a prescribed dose of 60 Gy. The long-term survival and adverse reactions were compared between patients treated with the two different radiotherapy regimens. The survival rates were calculated by the Kaplan-Meier method and analyzed by the log-rank test. Results The 5-and 7-year sample sizes were 239 and 120, respectively. The 3DCRT group had significantly lower 1-, 3-, 5-, and 7-year local control (LC) and overall survival (OS) rates than the IMRT group (64.4% vs. 68.3%, 40.6% vs. 55.3%, 38.3% vs. 51.9%, 34.2% vs. 51.9%, P=0.048;54.5% vs. 63.3%, 19.8% vs. 34.7%, 14.7% vs. 24.4%, 10.9% vs. 20.3%, P=0.013). The stratified analysis showed that for patients older than 65 years, with the length of esophageal lesion>8.0 cm before radiotherapy, the largest diameter of esophageal lesion in computed tomography image>4.6 cm, gross tumor volume (GTV)>60 cm³, metastases to adjacent tissues or organs, stage N₂, and without chemotherapy, the IMRT group had a significantly higher OS rate than the 3DCRT group (P=0.022,0.003,0.022,0.034,0.016,0.044,0.047). The GTVD_min and GTVD₁₀₀ were significantly higher in the IMRT group than in the 3DCRT group (P=0.000,0.000), while the D_max of the spinal cord was significantly lower in the IMRT group than in the 3DCRT group (P=0.000). Compared with the 3DCRT group, the IMRT group had a significantly higher incidence of acute radiation-induced esophagitis, particularly grade 1-2 esophagitis (P=0.000). The mortality rate caused by local tumor was significantly higher in the 3DCRT group than in the IMRT group (P=0.039). Conclusions In the treatment of locally advanced middle and lower thoracic esophageal carcinoma, IMRT is safe and effective;it significantly improves the LC rate and long-term survival without severe toxicity to normal tissues. The results of this retrospective study need to be confirmed by prospective randomized controlled studies.

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

收稿日期: 2016-05-23

通讯作者: 韩春,Email:hanchun2006@126.com

引用本文:

任雪姣,王澜,韩春等. T₄N (+)Ⅲ期食管胸中下段癌3DRT长期生存分析[J]. 中华放射肿瘤学杂志, 2017, 26(1): 29-34.

Ren Xuejiao,Wang Lan,Han Chun et al. Long term survival analysis of middle and lower thoracic esophageal carcinoma of stage T₄N (+) treated with 3DRT[J]. Chinese Journal of Radiation Oncology, 2017, 26(1): 29-34.

链接本文:

http://journal12.magtechjournal.com/Jweb_fszlx/CN/10.3760/cma.j.issn.1004-4221.2017.01.006 或 http://journal12.magtechjournal.com/Jweb_fszlx/CN/Y2017/V26/I1/29

[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] 万钧,肖爱勤,高淑珍,等.食管癌放疗后近期疗效评价标准——附1000例分析[J].中国放射肿瘤学,1989,3(4):205-207.
Wan J,Xiao AQ,Gao SZ,et al. Criteria of evaluation of immediate response of radiation therapy for esophageal carcinoma——Report on 1000 patients[J].Chin Radiat Oncol,1989,3(4):205-207.
[3] Wang D,Yang Y,Zhu J,et al.3D-conformal RT,fixed-field IMRT and RapidArc,which one is better for esophageal carcinoma treated with elective nodal irradiation[J].Technol Cancer Res Treat,2011,10(5):487-494.DOI:10.7785/tcrt.2012.500225.
[4] 白文文,周志国,宋玉芝,等.颈段食管癌三维适形与IMRT的剂量学及临床对比研究[J].中华放射医学与防护杂志,2014,34(12):919-921.DOI:10.3760/cma.j.issn.0254-5098.2014.12.010.
Bai WW,Zhou ZG,Song YZ,et al. Cervical esophageal cancer with three-dimensional conformal IMRT dosimetry and clinical comparative study[J].Chin J Radiol Med Protect,2014,34(12):919-921.DOI:10.3760/cma.j.issn.0254-5098.2014.12.010.
[5] 葛小林,孙新臣,陈文湛,等.胸上段食管癌IMRT和3DCRT剂量学研究[J].中国医学物理学杂志,2010,27(2):1708-1711,1720.DOI:10.3969/j.issn.1005-202X.2010.02.003.
Ge XL,Sun XC,Chen WZ,et al. Dosimetry study of IMRT and 3DCRT radiotherapies for patients with upper esophageal carcinoma[J].Chin J Med Phys,2010,27(2):1708-1711,1720.DOI:10.3969/j.issn.1005-202X.2010.02.003.
[6] 李定杰,刘海龙,毛荣虎,等.胸中段、胸下段食管癌适形放疗和IMRT的剂量学研究[J].中国辐射卫生,2011,20(3):265-267.DOI:10.13491/j.cnki.issn.1004-714x.2011.03.071.
Li DJ,Liu HL,Mao RH,et al. Comparison of dose distribution between 3DCRT and IMRT in middle thoracic and under thoracic esophageal carcinoma[J].Chin J Radiol Health,2011,20(3):265-267.DOI:10.13491/j.cnki.issn.1004-714x.2011.03.071.
[7] 姜世文,赵佳莹,钟文,等.食管癌适形与IMRT技术剂量参数比较的Meta分析[J].现代肿瘤医学,2016,24(4):566-571.DOI:10.3969/j.issn.1672-4992.2016.04.017.
Jiang SW,Zhao JY,Zhong W,et al. Dosimetric parameters between three-dimensional conformal radiotherapy and intensity modulated radiotherapy for esophageal cancer radiotherapy:a Meta-analysis[J].J Mod Oncol,2016,24(4):566-571.DOI:10.3969/j.issn.1672-4992.2016.04.017.
[8] 王玉祥,王军,王祎,等.食管癌伴区域淋巴结转移三维适形与IMRT疗效初步比较[J].中华放射肿瘤学杂志,2011,20(6):489-493.DOI:10.3760/cma.j.issn.1004-4221.2011.06.013.
Wang YX,Wang J,Wang Y,et al. Prognosis comparison of three-dimensional conformal radiotherapy/intensity modulated radiation therapy for esophageal carcinoma with localregional lymph node metastasis[J].Chin J Radiat Oncol,2011,20(6):489-493.DOI:10.3760/cma.j.issn.1004-4221.2011.06.013.
[9] 孔洁,李晓宁,韩春,等.792例食管癌三维技术放疗的疗效分析[J].中华放射肿瘤学杂志,2012,21(5):421-424.DOI:10.3760/cma.j.issn.1004-4221.2012.05.007.
Kong J,Li XN,Han C,et al. Treatment outcomes of 792 cases of esophageal carcinoma patients treated with three-dimensional radiotherapy[J].Chin J Radiat Oncol,2012,21(5):421-424.DOI:10.3760/cma.j.issn.1004-4221.2012.05.007.
[10] Gaspar LE,Winter K,Kocha WI,et al. A phase Ⅰ/Ⅱ study of external beam radiation,brachytherapy,and concurrent chemotherapy for patients with localized carcinoma of the esophagus (Radiation Therapy Oncology Group Study 9207):final report[J].Cancer,2000,88(5):988-995.
[11] Ling TC,Slater JM,Nookala P,et al. Analysis of intensity-modulated radiation therapy (IMRT),proton and 3D conformal radiotherapy (3DCRT) for reducing perioperative cardiopulmonary complications in esophageal cancer patients[J].Cancers,2014,6(4):2356-2368.DOI:10.3390/cancers6042356.
[12] 王澜,李晓宁,吕冬婕,等.肺低剂量区体积预测急性放射性肺炎价值探讨[J].中华放射肿瘤学杂志,2010,19(4):296-300.DOI:10.3760/cma.j.issn.1004-4221.2010.04.005.
Wang L,Li XN,L DJ,et al. Low dose volume of the lung in prediction of acute radiation pneumonitis[J].Chin J Radiat Oncol,2010,19(4):296-300.DOI:10.3760/cma.j.issn.1004-4221.2010.04.005.