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目的:研究三维适形放疗治疗32例食管癌γ-刀放疗后复发的可行性,观察其近期疗效与安全性。方法:对32例食管癌γ-刀放疗后复发患者实施三维适形放疗,评价急性放疗反应及近期疗效。结果:28例患者顺利完成放疗计划,初次放疗与再次放疗中位间隔时间7月,再次放疗中位剂量57.6Gy,近期完全缓解率9%,部分缓解率69%,稳定9%,进展13%,总治疗总有效率为78%。患者急性放射性食管炎发生率1-2级16%(5/32),3-4级31%(10/32);急性放射性肺炎发生率1-2级16%(5/32),3-4级9%(3/32);骨髓抑制的发生率为47%,1-2级37.5%(12/32),3-4级9.5%(3/32),急性心脏损伤发生率3%,1-2级3%(1/32),3-4级0%(0/32)。结论:三维适形放疗治疗γ-刀放疗后复发食管癌的近期疗效较好,患者可耐受,晚期并发症及疗效有待进一步观察。
Objective: To study the feasibility of three-dimensional conformal radiotherapy in the treatment of esophageal cancer recurrence after γ-knife radiotherapy in 32 patients, and to observe its short-term curative effect and safety. Methods: Three-dimensional conformal radiotherapy was performed on 32 patients with esophageal cancer recurrence after γ-knife radiotherapy to evaluate the acute radiation response and the short-term curative effect. Results: 28 patients successfully completed the radiotherapy plan. The median interval between initial radiotherapy and reradiation was 7 months. The median dose of reradiation was 57.6Gy. The recent complete remission rate was 9%, partial remission rate was 69%, stable rate was 9%, and progress was 13% , The total effective rate of treatment was 78%. The incidence of acute radiation esophagitis in patients with grade 1-2 16% (5/32), Grade 3-4 31% (10/32); acute radiation pneumonitis grade 1-2 16% (5/32), 3- Grade 4 9% (3/32), bone marrow suppression 47%, grade 1-2 37.5% (12/32), grade 3-4 9.5% (3/32), acute heart injury 3% , Grade 1-2 3% (1/32), Grade 3-4 0% (0/32). Conclusion: Three-dimensional conformal radiotherapy for the treatment of γ-knife radiotherapy recurrence of esophageal cancer better efficacy, patient tolerance, advanced complications and efficacy needs further observation.