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目的探讨颈段食道癌全程适形调强放射治疗(Intensity modulated radiation therapy IMRT)疗效。方法自2005年1月至2008年1月,选择50例颈段食管癌患者利用TOPSLANE DMLC IMRT系统,采用热可塑面膜固定头颈肩部或真空负压垫固定体部。行颅底骨至肺底层厚为3mm CT扫描;图像重建,勾画出病灶及重要功能器官的轮廓。肿瘤靶区(GTV)为临床检查、CT、MRI及PET CT等影像检查发现的肿瘤病灶,包括原发肿瘤、咽旁和颈部的转移淋巴结,考虑摆位误差外放3mm;临床靶区(CTV)包括颈部淋巴引流区、双锁骨上区及上纵隔,计划靶区(PTV)按照CTV外放5mm(后界3mm)。计划设计:5次/周,共28～32次,GTVDT=2.0～2.5Gy/次,总DT=60Gy～73Gy。主要保护的器官和组织包括脊髓、双肺、咽喉等,脊髓限制剂量40 Gy以下,咽喉30 Gy,双肺V20 20%。随机抽取符合入组条件的50例颈段食管癌适形放疗患者为对照组。结果 50例颈段食道癌病人IMRT治疗后1、2、3年生存率和控制率为94%,82%,54%和98%,82%、74%,食道癌病人3DCRT治疗后1、2、3年生存率和控制率为76%,66%,42%和76%,64%,58%,有统计学意义(P<0.05)。结论 IMCRT能够使高剂量区均匀准确分布于病灶及亚临床灶区,同时有效保护脊髓、咽喉、双肺等重要器官和组织,提高肿瘤治疗剂量,从而提高局部控制率和生存率。
Objective To investigate the effect of Intensity modulated radiation therapy (IMRT) on cervical esophageal cancer. Methods From January 2005 to January 2008, 50 patients with cervical esophageal cancer were selected by TOPSLANE DMLC IMRT system and fixed with thermal plastic mask on the head and neck shoulder or vacuum negative pressure pad. The skull base to the lung bottom thickness of 3mm CT scan; image reconstruction, outline the outline of lesions and important functional organs. The tumor target area (GTV) is a tumor focus found in clinical examination, CT, MRI and PET CT imaging examinations, including metastatic lymph nodes of the primary tumor, parapharyngeal and neck, taking into account the positioning error of 3mm; clinical target area CTV) included the lymphatic drainage of the neck, the supraclavicular region, and the superior mediastinum. The planned target volume (PTV) was placed 5 mm (posterior 3 mm) according to CTV. Design: 5 times / week, a total of 28 to 32 times, GTVDT = 2.0 ~ 2.5Gy / times, total DT = 60Gy ~ 73Gy. The main organs and tissues to be protected include spinal cord, lungs, throat, etc. The dose of spinal cord is limited to 40 Gy, the throat is 30 Gy and the lungs are 20% of V20. 50 cases of cervical cancer with conformal radiotherapy of cervical cancer were selected randomly as the control group. Results The survival rates and control rates at 1, 2 and 3 years after IMRT in 50 patients with cervical esophageal cancer were 94%, 82%, 54% and 98%, 82% and 74%, respectively. The 3-year survival rate and control rate were 76%, 66%, 42% and 76%, 64% and 58%, respectively, with statistical significance (P <0.05). Conclusion The IMCRT can uniformly and accurately distribute the high-dose region in the lesion and subclinical region, and effectively protect the vital organs and tissues such as the spinal cord, throat and lungs and improve the therapeutic dose of the tumor, so as to improve the local control rate and survival rate.