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目的探讨适形调强放疗与常规放疗治疗80岁以上老年人食管癌的疗效及毒副反应。方法回顾性分析2009年11月—2012年10月收住肿瘤放疗科并完成根治性放射治疗的80岁以上食管癌患者共41例。其中适形调强放疗18例,常规放疗23例,总处方剂量DT 48~69 Gy,24~34次完成。统计2组的近期、远期疗效、症状缓解率及毒副反应。采用Kaplan-Meier法和Log-rank法分析比较生存率。结果适形调强组、常规放疗组近期有效率分别为88.9%、60.9%(χ~2=4.308,P=0.044);中位生存期分别为12个月和9个月,其1年、3年生存率分别为44.4%(8/18)、21.7%(5/23)和16.7%(3/18)、4.3%(1/23)(χ~2=5.919,P=0.015)。适形调强组症状缓解率83.3%(15/18),常规放疗组症状缓解率82.6%(19/23),2组比较差异无统计学意义(χ~2=0.004,P=0.951)。在毒副反应方面,主要不良反应为Ⅰ~Ⅱ度放射性食管炎、放射性肺炎、骨髓抑制及食欲减退,2组均未出现3级以上放疗反应。结论对于80岁以上食管癌患者,放射治疗是一种安全有效的治疗手段,采用适形调强放射治疗可以进一步提高疗效。
Objective To investigate the efficacy and side effects of conformal IMRT and conventional radiotherapy in the treatment of esophageal cancer in the elderly over 80 years old. Methods A total of 41 patients with esophageal cancer over the age of 80 were admitted to our hospital from November 2009 to October 2012 and received radical radiotherapy. Among them, 18 cases of conformal IMRT, 23 cases of conventional radiotherapy, the total prescription dose DT 48 ~ 69 Gy, 24 to 34 times to complete. Statistics 2 groups of short-term, long-term efficacy, symptoms and toxicity and side effects. Survival rates were compared using the Kaplan-Meier method and Log-rank analysis. Results The short-term effective rates were 88.9% and 60.9% (χ ~ 2 = 4.308, P = 0.044) in the CRT group and the conventional radiotherapy group respectively. The median survival time was 12 months and 9 months respectively, The 3-year survival rates were 44.4% (8/18), 21.7% (5/23), 16.7% (3/18) and 4.3% (1/23) respectively (χ ~ 2 = 5.919, P = 0.015). The symptom relief rate was 83.3% (15/18) in the IOP group and 82.6% (19/23) in the conventional radiotherapy group. There was no significant difference between the two groups (χ ~ 2 = 0.004, P = 0.951). In terms of toxic side effects, the main adverse reactions were grade Ⅱ-Ⅱ esophagitis, radiation pneumonitis, myelosuppression and loss of appetite. No grade 3 or more radiotherapy was found in both groups. Conclusions Radiation therapy is a safe and effective treatment for patients with esophageal cancer over the age of 80, and the use of conformal intensity modulated radiation therapy can further improve the therapeutic effect.