不同剂量放疗治疗44例晚期食管癌患者的生存分析
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摘要
目的:探讨Ⅳ期食管癌患者行不同剂量放射治疗后生存率等指标的差异。方法:选择成都军区总医院2006年1月至2009年4月44例接受过高剂量或低剂量放疗,并均行同步化疗的Ⅳ期食管癌患者,回顾性分析其生存率、急性放射性损伤发生率等指标,并分析影响生存的相关因素。结果:高剂量放疗组总有效率及局控率明显高于低剂量组(P<0.01);高剂量组1年总生存率(overall survival rate,OS)为63.6%,2年和3年OS分别为40.1%和7.7%;低剂量组1、2、3年OS分别为41.9%、10.9%、1.4%,整体比较提示高剂量组生存时间较低剂量组延长(P=0.003);OS与年龄、放疗方式、烟酒史相关(P<0.001)。放射性损伤发生率:肺损伤、骨髓抑制组间无差异,食管炎高剂量较低剂量组明显增加。结论:治疗前PS评分≤1的Ⅳ期食管癌患者行高剂量放疗可明显提高局控、总有效率与OS;年龄≤60岁,行高剂量放疗及无烟酒史的患者总生存受益更多;行高剂量放疗患者放射性损伤的发生率在临床可接受范围。
Objective:To evaluate the efficacy and acute radiation injury in stage IV esophageal cancer patients after radiation therapy with varying doses.Methods:A total of 44 patients with clinical stage IV esophageal squamous cell carcinoma who underwent high-or low-dose radiotherapy of the cancer with synchronized chemotherapy in General Hospital of Chengdu Military Command of PLA between January 2006 and April 2009 were enrolled.The patients were divided into two groups:the patients who underwent high-dose radiotherapy were assigned as Group A [ D99GTV:(6271.43±167.17) cGy,D95PTV:(5862.17±247.64) cGy ],and those with low dose irradiation [D99GTV:(5269.77±721.64) cGy,D95PTV:(4731.37±862.21) cGy ] were in Group B.The overall survival (OS) rates and radiation injury were evaluated retrospectively,including the correlation factors that affected survival.Results: The total effective rate and local control rate were significantly higher in Group A than in Group B (P<0.01).The 1-,2-,and 3-year overall survival (OS) rates were 63.6%,40.1%,and 7.7% in Group A,and 41.9%,10.9%,and 1.4% in Group B (P=0.003).There was a significantly prolonged survival time in Group A than in Group B (P=0.003).OS was correlated with patient age,dose of radiation therapy,and history of smoking and alcohol intake (P<0.001).Acute radiation-related esophagitis was more serious in Group A than in Group B (P<0.05).However,there were no differences between the groups in terms of lung injury and bone marrow suppression. Conclusion:High-dose radiotherapy conducted for stage Ⅳ esophageal cancer patients with pretherapeutic PS scoring ≤ 1 can apparently increase the local control rate,overall effectiveness,and OS of the disease.There is a high beneficial rate of OS rate in patients ≤ 60 years that are undergoing high-dose radiotherapy and without a history of smoking or alcohol intake.The incidence rate of the acute radiation injury is clinically tolerated among patients who undergo high-dose irradiation.
Objective:To evaluate the efficacy and acute radiation injury in stage IV esophageal cancer patients after radiation therapy with varying doses.Methods:A total of 44 patients with clinical stage IV esophageal squamous cell carcinoma who underwent high-or low-dose radiotherapy of the cancer with synchronized chemotherapy in General Hospital of Chengdu Military Command of PLA between January 2006 and April 2009 were enrolled.The patients were divided into two groups:the patients who underwent high-dose radiotherapy were assigned as Group A [ D99GTV:(6271.43±167.17) cGy,D95PTV:(5862.17±247.64) cGy ],and those with low dose irradiation [D99GTV:(5269.77±721.64) cGy,D95PTV:(4731.37±862.21) cGy ] were in Group B.The overall survival (OS) rates and radiation injury were evaluated retrospectively,including the correlation factors that affected survival.Results: The total effective rate and local control rate were significantly higher in Group A than in Group B (P<0.01).The 1-,2-,and 3-year overall survival (OS) rates were 63.6%,40.1%,and 7.7% in Group A,and 41.9%,10.9%,and 1.4% in Group B (P=0.003).There was a significantly prolonged survival time in Group A than in Group B (P=0.003).OS was correlated with patient age,dose of radiation therapy,and history of smoking and alcohol intake (P<0.001).Acute radiation-related esophagitis was more serious in Group A than in Group B (P<0.05).However,there were no differences between the groups in terms of lung injury and bone marrow suppression. Conclusion:High-dose radiotherapy conducted for stage Ⅳ esophageal cancer patients with pretherapeutic PS scoring ≤ 1 can apparently increase the local control rate,overall effectiveness,and OS of the disease.There is a high beneficial rate of OS rate in patients ≤ 60 years that are undergoing high-dose radiotherapy and without a history of smoking or alcohol intake.The incidence rate of the acute radiation injury is clinically tolerated among patients who undergo high-dose irradiation.
引文
1 殷蔚伯,余子豪,徐国镇,等,主编.肿瘤放射治疗学[M].第四版.北京:中国协和医科大学出版社,2008:546～574．
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4 Shirai K,Tamaki Y,Kitamoto Y,et al.Comparison of chemoradio-therapy with radiotherapy alone in patients with esophageal adenocarcinoma[J].Radiat Res,2011,19(2) :1-6．
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9 周希法,周健许锡元,等.逐级加量全程加速超分割放射治疗食管癌的研究[J].中国肿瘤临床,2008,35(23) :1328-1334．
10 陆进成,刘菊英,朱向帜.食管癌放射治疗时间-剂量效应的临床研究[J].河南肿瘤学杂志,2004,17(2) :41-43．
11 Graham MV,PurdyJA,Emami B,et al.Clinical dose-volume histogram analysis for peneumoniu's after 3D treatment for non-small cell lung cancer(NSCLC)[J].Int J Radiat Oncol Biol Phys,1999,45(2) :323-329．
12 唐求,王鹏.放射性肺损伤的早期预测指标[J].临床肺科杂志,2009,14(8) :1058-1060．
13 Alevronta E,Ahlberg A,Mavroidis P,et al.Dose-response relations for stricture in the proximal oesophagus from head and neck radio-therapy[J].Radiother Oncol,2010,97(1) :54-59．
2 李维贵,张德州,丁金亮,等.综合治疗中晚期食管癌200例临床分析[J]中华放射肿瘤学杂志,2001,10(4) :273．
3 李彩英,刘明,彰俊杰,等.304例非手术食管癌T分期与生存期相关性分析[J].中国肿瘤临床,2006,33(10) :565-567．
4 Shirai K,Tamaki Y,Kitamoto Y,et al.Comparison of chemoradio-therapy with radiotherapy alone in patients with esophageal adenocarcinoma[J].Radiat Res,2011,19(2) :1-6．
5 万钧,韩春,刘惠明,等,主编.食管癌的放射治疗[M].修订版.北京:原子能出版社,2006:157-160
6 Chandra A,Guerrero TM,Liu HH,et al.Feasibility of using intensity-modulated radiotherapy to improve lung sparing in treatment planning for distal esophageal cancer[J].Radiother Oncol,2005,77(3) :247-253．
7 Fu WH,Wang LH,Zhou ZM,et al.Comparison of conformal and intensity-modulated techniques for simultaneous integrated boost radiotherapy of upper esophageal carcinoma[J].World J Gastroenterol,2004,10(8) :1098-1102．
8 师颖瑞,吴湘玮,陈艳平,等.后程加速超分割适形放疗加同步化疗治疗食管癌的临床观察[J].中华肿瘤防治,2008,15(12) :943-945．
9 周希法,周健许锡元,等.逐级加量全程加速超分割放射治疗食管癌的研究[J].中国肿瘤临床,2008,35(23) :1328-1334．
10 陆进成,刘菊英,朱向帜.食管癌放射治疗时间-剂量效应的临床研究[J].河南肿瘤学杂志,2004,17(2) :41-43．
11 Graham MV,PurdyJA,Emami B,et al.Clinical dose-volume histogram analysis for peneumoniu's after 3D treatment for non-small cell lung cancer(NSCLC)[J].Int J Radiat Oncol Biol Phys,1999,45(2) :323-329．
12 唐求,王鹏.放射性肺损伤的早期预测指标[J].临床肺科杂志,2009,14(8) :1058-1060．
13 Alevronta E,Ahlberg A,Mavroidis P,et al.Dose-response relations for stricture in the proximal oesophagus from head and neck radio-therapy[J].Radiother Oncol,2010,97(1) :54-59．