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[目的]探讨食管癌三维适形放疗三种时间—剂量分割方式的疗效及副反应。[方法]选择未经治疗的食管癌患者169例,随机分为A(2Gy/次,5次/周,共30～33次)、B(2.5Gy/次,5次/周,共21～23次)和C(3.0Gy/次,5次/周,共16～18次)组,总剂量DT60～66Gy,中位剂量64Gy。[结果]近期有效率A组、B组和C组相似(95%、96%、95%,χ2=2.33,P=0.350);完全缓解率三组亦无显著差异(75%、80%、77%,χ2=0.91,P=0.630)。3年生存率B组最高(36%、57%、39%,χ2=6.13,P=0.047);3年局部控制率B组亦较高(36%、57%、51%,χ2=5.42,P=0.067)。早期2、3级放射性食管炎(27%、36%、52%,χ2=7.01,P=0.030,4%、9%、21%,χ2=7.60,P=0.023)和放射性肺炎(16%、27%、37%,χ2=6.23,P=0.041,0、4%、9%,χ2=5.54,P=0.064)发生率C组最高;晚期2、3级放射性食管炎C组最高(13%、18%、32%,χ2=6.68,P=0.037;4%、9%、18%,χ2=6.25,P=0.040);3级晚期放射性肺炎发生率C组亦最高(0、5%、11%,χ2=6.21,P=0.041)。[结论]常规2.5Gy/次,5次/周分割方式比常规分割治疗效果好,副反应可接受,可考虑作为三维适形放疗食管癌的治疗模式。
[Objective] To investigate the curative effect and side effects of three time-dose segmentation methods for three-dimensional conformal radiotherapy of esophageal cancer. [Methods] A total of 169 patients with untreated esophageal cancer were randomly divided into A (2Gy / time, 5 times / week for 30-33 times), B (2.5 Gy / time, 5 times / 23 times) and C (3.0 Gy / time, 5 times / week, 16 ~ 18 times). The total dose of DT60 ~ 66Gy, the median dose of 64Gy. [Results] The recent efficiency was similar in groups A, B and C (95%, 96%, 95%, χ2 = 2.33, P = 0.350). There was no significant difference in complete remission rates among the three groups (75%, 80% 77%, χ2 = 0.91, P = 0.630). The 3-year survival rate was the highest in group B (36%, 57%, 39%, χ2 = 6.13, P = 0.047) P = 0.067). Grade 2 and 3 radiation esophagitis (27%, 36%, 52%, χ2 = 7.01, P = 0.030,4%, 9%, 21%, χ2 = 7.60, 27%, 37%, χ2 = 6.23, P = 0.041,0,4%, 9%, χ2 = 5.54, P = 0.064) (P = 0.037; 4%, 9%, 18%, χ2 = 6.25, P = 0.040). The incidence of grade 3 advanced pneumonitis was also highest in group C (0, 5% 11%, χ2 = 6.21, P = 0.041). [Conclusion] Conventional 2.5Gy / time, 5 times / week segmentation is more effective than conventional segmentation and acceptable side effects. It can be considered as the treatment mode for three dimensional conformal radiation therapy of esophageal cancer.