Nishimura Y, Ono K, Tsutsui K, Oya N, Okajima K, Hiraoka M, Abe M
Department of Radiology, Faculty of Medicine, Kyoto University, Japan.
Int J Radiat Oncol Biol Phys. 1994 Dec 1;30(5):1099-105. doi: 10.1016/0360-3016(94)90315-8.
Local control rate and survival rate of esophageal cancer treated with radical radiation therapy (RT) were analyzed with special respect to total treatment time and fractionation.
Between 1979 and 1992, 88 patients with Stages I-III esophageal cancer were treated radically with RT at Kyoto University Hospital and Wakayama Red Cross Hospital. Of the 88 patients, 52 patients were treated with conventional fractionation (1.7-2.0 Gy/day, five times/week), and the remaining 36 patients were treated with accelerated hyperfractionation (AHF). In 1989, we started AHF regimen for esophageal cancer. Daily fractionations were 2.0 Gy and 1.2 Gy (field-in-field), or 1.5 Gy and 1.5 Gy at 5- to 6-h interval. Most of the patients treated with AHF received the total radiation dose of 64-68 Gy. Twenty-seven patients were treated with intraluminal brachytherapy (IBT) as boost therapy following external RT. Fourteen patients were treated with IBT following AHF.
The median of treatment time of AHF was approximately 2 weeks shorter than that of conventional fractionation. Local control rate at 1 year were 47% for AHF, which was significantly higher than that for conventional fractionation (22%, p < 0.05). The improvement of local control by AHF was responsible for a trend to an improved cause-specific survival (p = 0.07). Local control rates at 1 year were plotted as a function of total treatment time. The slope of the linear regression line was -2.3 +/- 0.5% per day (p < 0.025) for patients treated with external RT alone, indicating a 2.3% per day loss in local control. Pretreatment and treatment parameters were evaluated in a multivariate analysis for the end point of local control. T stage (T1, 2 vs. T3, 4; p = 0.003) and fractionation schedule (p = 0.03) were independent of prognostic significance. Patients could tolerate the AHF well, although esophageal stenosis was noted frequently as a late toxicity.
Accelerated hyperfractionation was the most important treatment-related variable in this patient population. Total treatment time may have a significant impact on the treatment outcome for esophageal cancer.
分析根治性放射治疗（RT）食管癌的局部控制率和生存率，特别关注总治疗时间和分割方式。
1979年至1992年间，京都大学医院和和歌山县红十字医院对88例I - III期食管癌患者进行了根治性RT治疗。88例患者中，52例采用常规分割（1.7 - 2.0 Gy/天，每周5次），其余36例采用加速超分割（AHF）治疗。1989年，我们开始对食管癌采用AHF方案。每日分割剂量为2.0 Gy和1.2 Gy（野中野），或1.5 Gy和1.5 Gy，间隔5至6小时。大多数接受AHF治疗的患者总放射剂量为64 - 68 Gy。27例患者在体外RT后接受腔内近距离放疗（IBT）作为强化治疗。14例患者在AHF后接受IBT治疗。
AHF的治疗时间中位数比常规分割短约2周。AHF组1年局部控制率为47%，显著高于常规分割组（22%，p < 0.05）。AHF对局部控制的改善导致特定病因生存率有改善趋势（p = 0.07）。将1年局部控制率绘制成总治疗时间的函数。对于仅接受体外RT治疗的患者，线性回归线的斜率为每天-2.3±0.5%（p < 0.025），表明局部控制每天损失2.3%。在局部控制终点的多因素分析中评估了治疗前和治疗参数。T分期（T1、2与T3、4；p = 0.003）和分割方案（p = 0.03）具有独立的预后意义。患者对AHF耐受性良好，尽管食管狭窄经常被视为晚期毒性反应。
在该患者群体中，加速超分割是与治疗相关的最重要变量。总治疗时间可能对食管癌的治疗结果有显著影响。
