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
2期
136-139
,共4页
章文成%王奇峰%肖泽芬%王绿化%张红星%陈东福%冯勤付%周宗玫%梁军%惠周光%殷蔚伯
章文成%王奇峰%肖澤芬%王綠化%張紅星%陳東福%馮勤付%週宗玫%樑軍%惠週光%慇蔚伯
장문성%왕기봉%초택분%왕녹화%장홍성%진동복%풍근부%주종매%량군%혜주광%은위백
食管肿瘤/外科学%调强放射疗法,术后%三维适形放射疗法,术后%预后
食管腫瘤/外科學%調彊放射療法,術後%三維適形放射療法,術後%預後
식관종류/외과학%조강방사요법,술후%삼유괄형방사요법,술후%예후
Esophageal neoplasms/surgery%Intensity-modulated radiotherapy,postoperative%Three-dimensional conformal radiotherapy,postoperative%Prognosis
目的 分析三维适形放疗(3DCRT)或调强放疗(IM RT)技术对Ⅱ、Ⅲ期胸段食管癌根治术后预防性放疗的疗效及不良反应.方法 2004-2009年间本院行食管鳞状细胞癌根治术患者251例,术后病理分期为Ⅱ期95例、Ⅲ期156例.3DCRT的20例,IMRT的231例,中位剂量60 Gy.采用Kaplan-Meier法计算生存率并Logrank法检验和单因素预后分析,Cox回归模型多因素预后分析.结果 随访率为98.8％,随访满3、5年者分别为159、57例.全组1、3、5年生存率分别为90.8％、56.1％、45.8％.Ⅱa、Ⅱb、Ⅲ期的5年生存率分别65.0％、53.8％、38.4％(x2=7.30,P=0.026).淋巴结阴性与阳性的5年生存率分别64.9％、40.4％(x2=7.04,P=0.008).单因素分析显示病理分期、淋巴结是否转移、肿瘤分化程度、脉管瘤栓为影响预后因素(x2=7.30、7.04、8.34、9.40,P=0.026、0.008、0.004、0.002),多因素分析显示肿瘤分化程度、淋巴是否结转移、脉管瘤栓为影响预后因素(x2 =6.86、5.27、4.24,P=0.009、0.022、0.040).主要失败原因中血道转移58例、锁骨上淋巴结转移14例、腹腔淋巴结转移17例、胸腔内复发31例.主要晚期不良反应中≥2级吻合口狭窄5例、大出血8例.结论 3DCRT或IMTR技术对食管癌根治术后预防性放疗明显降低放疗部位复发率和提高生存率且不良反应低.Ⅲ期和有淋巴结转移食管癌术后患者应预防性放疗.
目的 分析三維適形放療(3DCRT)或調彊放療(IM RT)技術對Ⅱ、Ⅲ期胸段食管癌根治術後預防性放療的療效及不良反應.方法 2004-2009年間本院行食管鱗狀細胞癌根治術患者251例,術後病理分期為Ⅱ期95例、Ⅲ期156例.3DCRT的20例,IMRT的231例,中位劑量60 Gy.採用Kaplan-Meier法計算生存率併Logrank法檢驗和單因素預後分析,Cox迴歸模型多因素預後分析.結果 隨訪率為98.8％,隨訪滿3、5年者分彆為159、57例.全組1、3、5年生存率分彆為90.8％、56.1％、45.8％.Ⅱa、Ⅱb、Ⅲ期的5年生存率分彆65.0％、53.8％、38.4％(x2=7.30,P=0.026).淋巴結陰性與暘性的5年生存率分彆64.9％、40.4％(x2=7.04,P=0.008).單因素分析顯示病理分期、淋巴結是否轉移、腫瘤分化程度、脈管瘤栓為影響預後因素(x2=7.30、7.04、8.34、9.40,P=0.026、0.008、0.004、0.002),多因素分析顯示腫瘤分化程度、淋巴是否結轉移、脈管瘤栓為影響預後因素(x2 =6.86、5.27、4.24,P=0.009、0.022、0.040).主要失敗原因中血道轉移58例、鎖骨上淋巴結轉移14例、腹腔淋巴結轉移17例、胸腔內複髮31例.主要晚期不良反應中≥2級吻閤口狹窄5例、大齣血8例.結論 3DCRT或IMTR技術對食管癌根治術後預防性放療明顯降低放療部位複髮率和提高生存率且不良反應低.Ⅲ期和有淋巴結轉移食管癌術後患者應預防性放療.
목적 분석삼유괄형방료(3DCRT)혹조강방료(IM RT)기술대Ⅱ、Ⅲ기흉단식관암근치술후예방성방료적료효급불량반응.방법 2004-2009년간본원행식관린상세포암근치술환자251례,술후병리분기위Ⅱ기95례、Ⅲ기156례.3DCRT적20례,IMRT적231례,중위제량60 Gy.채용Kaplan-Meier법계산생존솔병Logrank법검험화단인소예후분석,Cox회귀모형다인소예후분석.결과 수방솔위98.8％,수방만3、5년자분별위159、57례.전조1、3、5년생존솔분별위90.8％、56.1％、45.8％.Ⅱa、Ⅱb、Ⅲ기적5년생존솔분별65.0％、53.8％、38.4％(x2=7.30,P=0.026).림파결음성여양성적5년생존솔분별64.9％、40.4％(x2=7.04,P=0.008).단인소분석현시병리분기、림파결시부전이、종류분화정도、맥관류전위영향예후인소(x2=7.30、7.04、8.34、9.40,P=0.026、0.008、0.004、0.002),다인소분석현시종류분화정도、림파시부결전이、맥관류전위영향예후인소(x2 =6.86、5.27、4.24,P=0.009、0.022、0.040).주요실패원인중혈도전이58례、쇄골상림파결전이14례、복강림파결전이17례、흉강내복발31례.주요만기불량반응중≥2급문합구협착5례、대출혈8례.결론 3DCRT혹IMTR기술대식관암근치술후예방성방료명현강저방료부위복발솔화제고생존솔차불량반응저.Ⅲ기화유림파결전이식관암술후환자응예방성방료.
Objective To analyze retrospectively the clinical therapeutic effect and toxicities of three-dimensional conformal radiotherapy ( 3DCRT) or intensity modulated radiotherapy ( IMRT) for resected stage Ⅱ/Ⅲ thoracic esophageal squamous cell carcinoma ( TESCC). Methods A total of 251
patients with resected TESCC underwent 3DCRT or IMRT at the Cancer Hospital ( Institute) , Chinese Academy of Medical Sciences between 2004. 1 t0 2009. 7 enrolled. Postoperative radiotherapy applied via 3DCRT ( 20 patients) or IMRT (231 patients) with a median total dose of 60 Gy. The Kaplan-Meier method
was used to calculate the survival rates, and the log-rank test was used for univariate analysis. The Cox proportional model was used for multivariate analysis. Results The follow-up rate was 98. 8％ . 159 and 57 patients were followed t0 3 and 5 years, respectively. The 1-, 3-and 5-year overall survival ( OS) rates for all the patients were 90. 8％ , 56. 1％ and 45. 8％ , respectively. For the stage Ⅱa, Ⅱb, and Ⅲ stage patients , the 5-year OS rates were 65. 0％ , 53. 8％ and 38. 4％ , respectively ( X2 = 7. 30 , P = 0.
026) . The 5-year OS rates were 64. 9％ and 40. 4％ for the patients with negative and positive lymph node metastasis ( X2 =7. 04 , P = 0. 008 ) . Univariate analysis showed that the significant prognostic factors
include UICC 2002 stage, the degree of differentiation, lymphatic metastasis and vascular carcinomatous thrombus ( X2 =7. 30 ,7. 04 , 8. 34 ,9. 40 , P = 0. 026 , 0. 008 , 0. 004 ,0.002 ) . Multivariate analysis revealed that
the grade of differentiation, lymphatic metastasis and vascular carcinomatous thrombus were independent prognostic factors ( X2 = 6. 86, 5. 27, 4. 24, P= 0. 009, 0. 022, 0. 040 ). Treatment failure occurred in 58 patients because of systemic metastases , 14 cervical lymph node recurrence , 17 abdominal lymph node metastases, and 31 0f intrathoracic recurrence. Five patients had grade 2 0r worse late treatment-related anastomotic stenosis , and 8 patients died from late treatment-related gastrointestinal bleeding. Conclusions Postoperative prophylactic 3DCRT or IMRT of TESCC can provide a favorable local control rate and acceptable toxicity. Postoperative radiotherapy should be included into the standard treatment of Stage Ⅲ
TESCC or TESCC with lymph node metastasis.
