中华放射肿瘤学杂志
中華放射腫瘤學雜誌
중화방사종류학잡지
CHINESE JOURNAL OF RADIATION ONCOLOGY
2012年
1期
38-41
,共4页
章文成%王奇峰%肖泽芬%杨龙海%刘向阳
章文成%王奇峰%肖澤芬%楊龍海%劉嚮暘
장문성%왕기봉%초택분%양룡해%류향양
食管肿瘤/外科学%术后失败部位%放疗靶区
食管腫瘤/外科學%術後失敗部位%放療靶區
식관종류/외과학%술후실패부위%방료파구
Esophageal neoplasms/surgery%Postoperative sites of failure%Radiotherapy target volumes
目的 分析胸段食管鳞状细胞癌根治术后首次复发部位,为进一步修改和完善术后放疗范围提供重要参考依据.方法 回顾分析1999-2007年间在本院行根治术并有明确复发部位记录的195例胸段食管癌患者不同段的首次复发、转移部位.结果 胸上、中段食管癌以胸腔内复发(83.3％、68.0％)为主要部位,而胸下段食管癌则以胸腔内复发(42.9％)和腹腔淋巴结转移(40.8％)为主.术后病理显示淋巴结有无转移与胸腔内复发、锁骨上淋巴结转移、远处转移均无关(χ2 =1.58、0.06、0.04,P=0.134、0.467、0.489),但腹腔淋巴结转移的术后淋巴结阳性比例高于阴性(28.7％:10.6％,χ2 =9.94,P=0.001),其中胸中段食管癌的也如此(20.0％:5.6％,χ2=5.67,P=0.015).切缘≤3 cm(52例)与＞3 cm(142例)者相比术后吻合口复发率明显增加(25.0％:11.3％,χ2=5.65,P=0.019).结论 胸腔内为最常见首次复发部位.建议胸上、中段(淋巴结阴性)食管癌放疗靶区包括锁骨上区、上纵隔和瘤床,胸中段(淋巴结阳性)、下段食管癌包括锁骨上区、全纵隔及胃左、腹腔干淋巴引流区.如切缘≤3 cm建议包括吻合口.
目的 分析胸段食管鱗狀細胞癌根治術後首次複髮部位,為進一步脩改和完善術後放療範圍提供重要參攷依據.方法 迴顧分析1999-2007年間在本院行根治術併有明確複髮部位記錄的195例胸段食管癌患者不同段的首次複髮、轉移部位.結果 胸上、中段食管癌以胸腔內複髮(83.3％、68.0％)為主要部位,而胸下段食管癌則以胸腔內複髮(42.9％)和腹腔淋巴結轉移(40.8％)為主.術後病理顯示淋巴結有無轉移與胸腔內複髮、鎖骨上淋巴結轉移、遠處轉移均無關(χ2 =1.58、0.06、0.04,P=0.134、0.467、0.489),但腹腔淋巴結轉移的術後淋巴結暘性比例高于陰性(28.7％:10.6％,χ2 =9.94,P=0.001),其中胸中段食管癌的也如此(20.0％:5.6％,χ2=5.67,P=0.015).切緣≤3 cm(52例)與＞3 cm(142例)者相比術後吻閤口複髮率明顯增加(25.0％:11.3％,χ2=5.65,P=0.019).結論 胸腔內為最常見首次複髮部位.建議胸上、中段(淋巴結陰性)食管癌放療靶區包括鎖骨上區、上縱隔和瘤床,胸中段(淋巴結暘性)、下段食管癌包括鎖骨上區、全縱隔及胃左、腹腔榦淋巴引流區.如切緣≤3 cm建議包括吻閤口.
목적 분석흉단식관린상세포암근치술후수차복발부위,위진일보수개화완선술후방료범위제공중요삼고의거.방법 회고분석1999-2007년간재본원행근치술병유명학복발부위기록적195례흉단식관암환자불동단적수차복발、전이부위.결과 흉상、중단식관암이흉강내복발(83.3％、68.0％)위주요부위,이흉하단식관암칙이흉강내복발(42.9％)화복강림파결전이(40.8％)위주.술후병리현시림파결유무전이여흉강내복발、쇄골상림파결전이、원처전이균무관(χ2 =1.58、0.06、0.04,P=0.134、0.467、0.489),단복강림파결전이적술후림파결양성비례고우음성(28.7％:10.6％,χ2 =9.94,P=0.001),기중흉중단식관암적야여차(20.0％:5.6％,χ2=5.67,P=0.015).절연≤3 cm(52례)여＞3 cm(142례)자상비술후문합구복발솔명현증가(25.0％:11.3％,χ2=5.65,P=0.019).결론 흉강내위최상견수차복발부위.건의흉상、중단(림파결음성)식관암방료파구포괄쇄골상구、상종격화류상,흉중단(림파결양성)、하단식관암포괄쇄골상구、전종격급위좌、복강간림파인류구.여절연≤3 cm건의포괄문합구.
Objective To analyze intrathoracic or extrathoracic recurrence pattern after surgical resection of thoracic esophageal squamous cell carcinoma (TESCC) and its help for further modify and improvement on the target of postoperative radiation therapy. Methods One hundred and ninety-five patients who had undergone resection of TESCC at the Cancer Hospital,Chinese Academy of Medical Sciences enrolled from April 1999 to July 2007.Sites of failure on different primary location of esophageal cancer were documented.Results Patients with upper or middle thoracic esophageal cancer had higher proportion of intrathoracic recurrence.Patients with lower thoracic esophageal cancer had more intrathoracic reccurence and abdominal lymph node metastatic recurrence.Histological lymph node status has nothing to do with intrathoracic recurrence,supraclavicular lymph node ( SLN ) metastasis or distant metastasis ( χ2 =1.58,0.06,0.04,P =0.134,0.467,0.489,respectively),whereas the chance of abdominal lymph node metastases in N positive patients was significantly higher than that in N0 patients (28.7％: 10.6％,χ2 =9.94,P =0.001 ),and so did in middle thoracic esophageal cancer ( 20.0％: 5.6％,χ2 =5.67,P =0.015). Anatomic recurrence rate of patients with proximal resection margin no more than 3 cm was significantly higher compared to those more than 3 cm (25.0％: 11.3％,χ2=5.65,P=0.019).Conclusions Mediastinum is the most common recurrence site.According to recurrence site,the following radiation targets are recommended:when tumor was located at the upper or middle thoracic esophagus with negative N status,the mediastinum,the tumor bed and the supraclavicular region should be included as postoperative RT target;when tumor was located at the middle thoracic esophagus with positive N or located at the lower thoracic esophagus,the abdominal lymph node should be added.If the proximal resection margin was no more than 3 cm,the anastomotic-stoma should be included.
