食管癌的放射治疗进展

摘要

3D-CRT/IMRT for patients with esophagcal cancer has been in practice for more than 10 years The overall survival rate is not satisfactory. Elective nodal radiation is controversial. Fudan Universery Shanghai Cancer Center's definition of csophageal cancer is when patients have a clinical tumor volume (CTV)=GTV (gross tumor volume)+3 cm margin in the SI direction; planning target volume (PTV)=CTV+1 cm margin in all directions no elective nodal radiation. PET can evaluate the response of radiation early on. With PET-CR, a patient can avoid operation and thus save the esophagus. Anti-EGFR inhibitors combined with chemoradiotherapy improved the response of chemoradiotherapy alone in a small number of studies. Several randomized clinical trials are ongoing.%食管癌放射治疗采用三维适形放疗(three dimensional conformal radiotherapy,3D-CRT)/调强放疗(intensity-modulated radiation tlaerapy,IMRT)已经10余年,但疗效并无突破性进展.是否需要进行淋巴结预防照射是目前讨论较多的问题.复旦大学肿瘤医院采用的方法是:临床靶体积(clinical targetvolume,CTV)=大体肿瘤体积(gross tumor volume,GTV)+上、下3 cm正常食管,计划靶体积(planning targetvolume,PTV)=CTV外放1 cm,并不进行淋巴结预防照射.PET/CT检查是早期评估食管癌放化疗疗效的有益手段,PET/CT有效的患者可能可以避免没有必要的手术,从而保留食管.靶向药物联合放化疗是目前的热点方向,EGFR拮抗剂体现了初步的疗效,多个随机分组试验正在进行中.