摘要
背景与目的:三维适形放疗(3-dimensional conformal radiotherapy,3D-CRT)/调强放疗(intensity-modulated radiation therapy,IMRT)治疗局部晚期食管鳞癌时,是否需要进行预防性照射存在争议。本研究分析用累及野照射食管癌的失败模式,探讨不进行淋巴结预防照射是否可行。方法:再次分析复旦大学附属肿瘤医院放疗科进行的一个食管癌全程加速超分割放疗的Ⅱ期前瞻性研究,统计这些病例的治疗失败模式。该研究包括43例初治的局部晚期食管鳞癌患者,均采用了3D-CRT/IMRT治疗,累及野照射:大体肿瘤靶区(gross tumor volume,GTV)为食管原发灶和肿大淋巴结(气管食管沟淋巴结短径≥0.5 cm,纵膈淋巴结≥1 cm),临床靶区(clinical target volume,CTV)为GTV+食管原发病灶上下3 cm的正常食管,计划靶区(planning target volume,PTV)为CTV外放1 cm。分割方法为每次1.5 Gy,每天2次,每周5 d,总放射剂量为60 Gy,共30 d,40次(单纯放疗)或57 Gy,共26 d,38次(同期放化疗)。结果:中位随访时间为24.7个月(11～41个月)。中位生存期为25个月,3年生存率为38.4%。治疗失败的25例患者中,单纯照射野内失败9例;野内复发合并野外淋巴结或脏器转移3例;单纯照射野外区域淋巴结转移1例,单纯照射野外远处淋巴结和(或)脏器转移10例,第二原发肿瘤1例,死因不明1例。结论:3D-CRT/IMRT治疗食管癌时,采用累及野照射治疗失败的主要原因是照射野内复发以及远处淋巴结和脏器转移,野外区域淋巴结转移率并不高,并且累及野照射有较高的总生存率。
Background and purpose： No consensus has been reached regarding the definitions of target volume for squamous cell carcinoma （SCC） of the esophagus. We analyzed the patterns of the failure associated with involved field after definitive radiotherapy, and to determine whether involved field is practicable in these patients. Methods： Secondary analysis of a prospective phase II trial in Fudan University Shanghai Cancer Center was done and analyzed the patterns of failure. In this trial, 43 new diagnozed patients with locoregional esophageal SCC were enrolled, and treated by accelerated hyperfractionated radiotherapy （AHRT）. 3D-CRT/IMRT techniques were used. The fractionation regimen of radiotherapy is 1.5 Gy/Fx, twice a day （interval of 6 hours）, 5 days per week, to a total dose of 60 Gy/40 Fx/30 d （radiation alone） or 57 Gy/38 Fx/26 d （concurrent chemoradiotherapy）. The definition of the target was： the gross tumor volume （GTV） was visible primary tumor and metastatic lymph nodes （nodes of ≥ 1 cm） in the shortest axis in the intrathoracic and intra-abdominal region and nodes beside the recurrent nerve with a shortest axis of ≥ 0.5 cm. The clinical target volume （CTV） was GTV plus 3 cm of proximal and distal normal esophagus without lateral margins. The planning target volume （PTV） was formed by adding a 1-cm margin around the CTV. Results： The median survival time was 24.7 months （1141 months）. The overall survival rate at 3 years was 38.4%. Twenty-five of the 53 patients showed treatment failure. Nine of the 43 patients developed an in-field recurrence, 13 patients had distant metastasis with or without regional failure, and 1 patient with an isolated out-of-field nodal recurrence only. One patient died of second tumor, respectively. Conclusion： The failure pattern in patients treated with 3D-CRT/IMRT for esophageal SCC was in-field failure and distant metastasis. The survival rate remained high.
出处
《中国癌症杂志》
CAS
CSCD
北大核心
2012年第8期601-604,共4页
China Oncology
关键词
食管癌
三维适形放疗
调强放疗
失败模式
Esophageal carcinoma
3-dimensional conformal radiotherapy
Intensity-modulated radiation therapy
Patterns of failure
