何珩 杨忠明 胡蝶

[摘要]目的針对食管癌患者在应用调强放射治疗（IMRT）方法进行治疗时，所产生的（主要针对放射治疗）疗效及其毒副反应，以期为食管癌患者治疗及预后等奠定理论基础。方法以2016年12月至2019年12月于西南医科大学附属中医医院肿瘤血液病科治疗的116例食管癌患者为研究对象，采取简单随机法分为对照组和研究组，每组各58例。对照组患者实行常规的化疗方式，研究组采取 IMRT 疗法。比较两组患者的疗效、毒副反应（放射性食管炎、放射性肺炎、骨髓抑制、胃肠道反应、手足综合征以及食管狭窄或穿孔的）、T 淋巴细胞亚群（CD3+、CD4+、CD8+、CD4+/CD8+）及 SF-36评分。结果研究组治疗的有效率为82.76%高于对照组的63.79%，差异有统计学意义（ P <0.05）;同时研究组治疗的疾病控制率为86.21%高于对照组的72.41%，差异有统计学意义（ P <0.05）。两组治疗后放射性食管炎、放射性肺炎、骨髓抑制、胃肠道反应、食管瘘以及食管狭窄或穿孔的发生率比较，差异无统计学意义（P >0.05）。治疗前两组的 CD3+、CD4+、CD8+及 CD4/CD8++比较，差异无统计学意义（P >0.05）;治疗后，研究组 CD3、CD4、CD4/CD8水平高于对照++++组，CD8+水平低于对照组，差异有统计学意义（ P <0.05）。两组患者不同时期的 SF-36评分比较，研究组治疗后1个月、治疗后2个月、治疗后3个月的 SF-36评分高于对照组，差异有统计学意义（ P <0.05）。结论食管癌患者采用 IMRT 方法治疗不但可有效提升疗效，降低毒副反应，还可以提升其生活质量，可在临床进行推广应用。

[关键词]食管癌; IMRT;毒副反应; T 淋巴细胞亚群

[中图分类号] R735.1  [文献标识码] A   [文章编号]2095-0616（2021）23-0205-05

Efficacy and toxicity of intensity modulated radiation therapy for esophageal cancer

HE  Heng    YANG  Zhongming    HU  Die

Department of Oncology and Hematology， the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University， Sichuan， Luzhou 646100， China

[Abstract] Objective To study the efficacy and side effects of intensity modulated radiation therapy （IMRT） in patients with esophageal cancer （EC）， so as to lay a theoretical foundation for the treatment and prognosis of EC patients. Methods  A total of 116 EC patients treated in Department of Oncology and Hematology of the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University from December 2016 to December 2019 were taken as examples and randomly divided into the control group and the study group， with 58 patients in each group. Patients in control group were treated with conventional chemotherapy， while patients in study group were treated with IMRT. The efficacy， toxicity （radiation esophagitis， radiation pneumonia， myelosuppression， gastrointestinal reaction， hand-foot syndrome and esophageal stenosis or perforation）， T lymphocyte subsets （CD3+， CD4+， CD8+， CD4+/CD8+） and SF-36 scores of the two groups were compared. Results The effective rate of the study group was 82.76%， higher than that of the control group （63.79%）， with statistically significant difference （P <0.05）. At the same time， the disease control rate in the study group was 86.21%， higher than that in the control group （72.41%）， with statistically significant difference （P <0.05）. After treatment， the incidences of radiation esophagitis， radiation pneumonia， myelosuppression， gastrointestinal reaction， esophageal fistula and esophageal stenosis or perforation between the two groups showed no significant differences （P >0.05）. There were no significant differences in CD3+， CD4+， CD8+ and CD4+/CD8+ between the two groups before treatment （P >0.05）. After treatment， the levels of CD3+， CD4+， CD4+/CD8+ in the study group were all higher than those in the control group， while the level of CD8+ was lower than that in the control group， with statistically significant differences （P <0.05）. The scores of SF-36 in different periods of the two groups showed that the scores of SF-36 in the study group after 1 month， 2 months and 3 months of treatment were higher than those in the control group， with statistically significant differences （P <0.05）. Conclusion IMRT can not onlyeffectively improve the curative effect， reduce toxic and side effects， but also improve the quality of life of EC patients， which can be widely used in clinic.

[Key words] Esophageal cancer; IMRT; Toxic and side effects; T lymphocyte subsets

食管癌（esophagus cancer）是一种发病率较高的恶性肿瘤，通常多发于中老年群体。每年世界范围内有超过30万人死于食管癌[1-2]。中国是食管癌发病率较高的国家，病死率占全世界食管癌病死率的一半左右[3-4]。由于患病后患者无法顺利吞咽食物，且机体消耗很大，会导致患者机体各项机能急速下降，严重影响患者的生存质量[5-7]。放射治疗是临床主要的治疗方式，但是单纯的放射治疗无法根据肿瘤大小和肿瘤的敏感性调整肿瘤照射的角度、剂量，疗效较为单一[8]。而适行调强放射治疗方式则有效改善了这一缺陷，能够根据患者患病范围确认的辐照区域内根据不同情况来调节强度、角度等。此方……