CAJ | 학술논문

目的：探讨食管癌根治性切除术后复发患者的放射治疗策略和预后因素。方法：回顾性分析病理确诊为食管癌且经R0切除后出现复发转移的66例患者，肿瘤中位复发时间10.6个月；50例患者局部区域复发，16例患者复发合并远处转移；全组患者中，单纯放疗10例，单纯化疗23例，放化联合治疗33例；联合放化疗组：先行化疗者22例，先行放疗者11例。放疗采用6MV-X线，中位放疗剂量60 Gy。结果：全组患者1、2、3年生存率和中位生存时间分别为61.9%、25.9%、16.5%和14.3个月（95%CI=12.4～16.2个月）。三种治疗模式中单纯化疗、单纯放疗和联合放化疗的患者中位生存时间分别为11.4、25.5和14.3个月（P=0.037）。复发合并远处转移的联合放化疗患者，先行化疗较先行放疗生存有获益（P=0.032）。单因素分析显示患者初治时的肿瘤分段、术式、复发是否合并转移、复发后治疗方式以及复发后是否放疗与患者预后相关（P<0.05）。多因素分析显示患者初始治疗时的肿瘤分段为影响患者预后的独立因素（P<0.01）。结论：术前食管癌分段或许能提示复发的预后；对于有远处转移的患者，先行化疗后再放疗，对延长生存更有益。
목적：탐토식관암근치성절제술후복발환자적방사치료책략화예후인소。방법：회고성분석병리학진위식관암차경R0절제후출현복발전이적66례환자，종류중위복발시간10.6개월；50례환자국부구역복발，16례환자복발합병원처전이；전조환자중，단순방료10례，단순화료23례，방화연합치료33례；연합방화료조：선행화료자22례，선행방료자11례。방료채용6MV-X선，중위방료제량60 Gy。결과：전조환자1、2、3년생존솔화중위생존시간분별위61.9%、25.9%、16.5%화14.3개월（95%CI=12.4～16.2개월）。삼충치료모식중단순화료、단순방료화연합방화료적환자중위생존시간분별위11.4、25.5화14.3개월（P=0.037）。복발합병원처전이적연합방화료환자，선행화료교선행방료생존유획익（P=0.032）。단인소분석현시환자초치시적종류분단、술식、복발시부합병전이、복발후치료방식이급복발후시부방료여환자예후상관（P<0.05）。다인소분석현시환자초시치료시적종류분단위영향환자예후적독립인소（P<0.01）。결론：술전식관암분단혹허능제시복발적예후；대우유원처전이적환자，선행화료후재방료，대연장생존경유익。
Objective:To evaluate the radiotherapeutic strategy for the treatment of recurrent esophageal cancer after radical re-section and determine relevant prognostic factors. Methods:A total of 66 patients with esophageal carcinoma and exhibited recurrence after radical surgery were retrospectively reviewed from Jan 2007 to Jun 2010. The median interval of recurrence from the initial sur-gery was 10.6 months. Among the 66 patients, 50 suffered from loco-regional recurrences alone, and 16 developed distant metastases in addition to loco-regional recurrences. Among the 66 patients, 10 were treated with radiotherapy after recurrence, 23 were treated with chemotherapy alone, and 33 were treated with radiotherapy combined with chemotherapy. Among the 33 patients, 22 were initially treat-ed with chemotherapy and 11 were initially treated with radiotherapy. The median total dose of the external radiotherapy was 60 Gy with 6 MV X-ray of a linear accelerator. Results:The median survival period after recurrence was 14.3 months (95%CI=12.4~16.2 months). The 1-, 2-, and 3-year survival rates were 61.9%, 25.9%, and 16.5%, respectively. The median survival period after recurrence in the patients who were treated with chemotherapy alone, radiotherapy alone, and radiotherapy combined with chemotherapy were 11.4, 25.5, and 14.3 months, respectively. The patients who developed distant metastases treated with chemotherapy initially showed better survival outcome than those treated with radiotherapy (P=0.032). Univariate analysis results showed the following prognostic factors:tumor location before surgery;operation mode;whether or not recurrence was detected with distant metastases;and therapy af-ter recurrence. Multivariate analysis results showed that tumor location before surgery was an independent prognostic factor. Conclu-sion:Tumor location may indicate prognosis after recurrence. Patients with recurrent esophageal carcinoma and developed distant me-tastases treated with chemotherapy may initially benefit from a longer survival rate.