CAJ | 학술논문

目的观察食管鳞状细胞癌三维技术放疗的局部控制率及生存率,并探讨影响因素.方法回顾分析2003-2008年收治的食管癌患者792例,采用三维适形放疗(672例)及调强放疗(120例)技术,1.8 ～2.0 Gy/次,5次/周,处方剂量50 ～ 70 Gy.同期放化疗142例,单纯放疗650例.Kaplan-Meier法计算局部控制率和生存率,Logrank法单因素预后分析,Cox法多因素预后分析.结果随访率为95.8％,随访时间满5年者133例.全组1、3、5年局部控制率分别为76.6％、53.2％、48.6％,总生存率分别为70.1％、36.7％、28.0％.单因素预后分析显示T分期、N分期、临床分期、肿瘤体积为影响生存的因素(x2=20.58～ 55.60,P均=0.000),多因素预后分析显示N分期、肿瘤体积为影响生存的因素(x2 =6.35、29.23,P=0.012、0.000).同期放化疗与单纯放疗的5年局部控制率分别为57.0％和46.8％(x2=7.34,P=0.007),5年总生存率分别为32.8％和27.6％(x2=3.42,P=0.064).结论三维技术放疗食管癌的远期疗效较二维技术放疗明显提高.T分期、N分期、TNM分期、肿瘤体积是长期生存影响因素.加入同期化疗可提高患者的局部控制率.
목적 관찰식관린상세포암삼유기술방료적국부공제솔급생존솔,병탐토영향인소.방법 회고분석2003-2008년수치적식관암환자792례,채용삼유괄형방료(672례)급조강방료(120례)기술,1.8 ～2.0 Gy/차,5차/주,처방제량50 ～ 70 Gy.동기방화료142례,단순방료650례.Kaplan-Meier법계산국부공제솔화생존솔,Logrank법단인소예후분석,Cox법다인소예후분석.결과 수방솔위95.8％,수방시간만5년자133례.전조1、3、5년국부공제솔분별위76.6％、53.2％、48.6％,총생존솔분별위70.1％、36.7％、28.0％.단인소예후분석현시T분기、N분기、림상분기、종류체적위영향생존적인소(x2=20.58～ 55.60,P균=0.000),다인소예후분석현시N분기、종류체적위영향생존적인소(x2 =6.35、29.23,P=0.012、0.000).동기방화료여단순방료적5년국부공제솔분별위57.0％화46.8％(x2=7.34,P=0.007),5년총생존솔분별위32.8％화27.6％(x2=3.42,P=0.064).결론 삼유기술방료식관암적원기료효교이유기술방료명현제고.T분기、N분기、TNM분기、종류체적시장기생존영향인소.가입동기화료가제고환자적국부공제솔.
Objective To investigate the long term clinical result of three-dimensional radiotherapy for esophageal carcinoma,discuss the effect of correlative factors to survival and local control.Methods From July 2003 to December 2008,792 patients with esophageal cancer were eligible.Patients were treated with three-dimensional radiotherapy (672 patients) or intensity-modulated (120 patients) radiotherapy.The radiotherapy was delivered in 1.8-2.0 Gy per fraction,5 fractions per week,total dose of 50-70 Gy,(median,60 Gy).142 patients were treated by concurrent radiochemotherapy,and the other 650 patients radiotherapy alone.The local control rate and survival rate were calculated by Kaplan-Meier method.Logrank method was used for univariate analyses.Cox regression model was used for multivariate analyses.Results The follow-up rate was 95.8％.The number of patients with 5 years time followed-up was 133.The 1-year,3-year and 5-year local control rates were 76.6％,53.2％,48.6％,and the 1-year,3-year and 5-year overall survival rates were 70.1％,36.7％ and 28.0％,respectively.There were significant influence on the prognosis of T stage,N stage,TNM stage,tumor volume ( x2 =20.58-55.60,all P =0.000).The Cox multivariate model showed that N stage and tumor volume were independent prognostic factors (x2 =6.35,29.23,P =0.012,0.000).For the two groups of concurrent chemo-radiotherapy and radiotherapy alone,5-year local control rates were 57.0％ and 46.8％ ( x2 =7.34,P =0.007 ),the 5-year overall survival rate 32.8％ and 27.6％ ( x2 =3.42,P =0.064.Conclusions Three-dimensional radiotherapy is effective for esophageal carcinoma.It might improve the local control rate and overall survival rate to some extent.T staging,N staging,TNM staging and tumor volume were important prognostic factors for long-term survival.The addition of concurrent radiochemotherapy could improve local control rates.