CAJ | 학술논문

目的探讨食管钡餐造影结合CT综合评价食管癌放疗近期疗效新标准的可行性.方法 2004-2010年经病理证实的食管癌患者189例,放疗前后均行食管钡餐造影及CT检查.通过测量分析放疗后CT示食管最大壁厚度及区域淋巴结体积变化,结合钡餐造影的近期疗效评价标准及随访结果,探讨新的疗效评价标准.结果钡餐造影评价标准依然有指导意义,但也有局限性.CT疗前115例有区域淋巴结转移者放疗后造影评价CR组仅局部控制率高于PR组,生存率无差异；而65例无区域淋巴结转移者CR、PR组局部控制率及生存率均有差异.综合分析认为放疗后造影评价CR、CT最大管壁厚度≤1.20 cm且放疗后残存淋巴结体积≤1.00 cm3者为CR;造影评价PR或CT最大管壁厚度＞ 1.20 cm者、造影评价CR且CT最大管壁厚度≤1.20 cm但放疗后残存淋巴结体积＞1.00 cm3者为部分缓解；造影评价NR或疗末CT有新发病灶者为无缓解或病情进展.新标准的CR与PR组局部控制率及生存率均有差异.结论单纯应用钡餐造影评价食管癌放疗近期疗效存在局限性,应以食管钡餐造影结合CT综合评价较为客观.
목적 탐토식관패찬조영결합CT종합평개식관암방료근기료효신표준적가행성.방법 2004-2010년경병리증실적식관암환자189례,방료전후균행식관패찬조영급CT검사.통과측량분석방료후CT시식관최대벽후도급구역림파결체적변화,결합패찬조영적근기료효평개표준급수방결과,탐토신적료효평개표준.결과 패찬조영평개표준의연유지도의의,단야유국한성.CT료전115례유구역림파결전이자방료후조영평개CR조부국부공제솔고우PR조,생존솔무차이；이65례무구역림파결전이자CR、PR조국부공제솔급생존솔균유차이.종합분석인위방료후조영평개CR、CT최대관벽후도≤1.20 cm차방료후잔존림파결체적≤1.00 cm3자위CR;조영평개PR혹CT최대관벽후도＞ 1.20 cm자、조영평개CR차CT최대관벽후도≤1.20 cm단방료후잔존림파결체적＞1.00 cm3자위부분완해；조영평개NR혹료말CT유신발병조자위무완해혹병정진전.신표준적CR여PR조국부공제솔급생존솔균유차이.결론 단순응용패찬조영평개식관암방료근기료효존재국한성,응이식관패찬조영결합CT종합평개교위객관.
Objective To investigate the feasibility of new criteria for evaluating the radiotherapeutic effect on esophageal cancer by barium meal (BM) combined with CT scans.Methods A total of 189 patients who were diagnosed with esophageal cancer (confirmed by biopsy) from January 2004 to December 2010 were enrolled as subjects.All patients underwent BM and CT scans before and after radiotherapy.The maximal esophageal wall thickness (EWT) and changes in the volumes of regional lymph nodes measured by CT scans were analyzed.New criteria for evaluating the short-term radiotherapeutic effect on esophageal cancer was studied considering the analysis results as well as the BM-based criteria for evaluating short-term radiotherapeutic effect and follow-up results.Results The BM-based evaluation criteria were still useful,but had certain limitations.There were 115 patients who had regional lymph node metastasis as detected by CT scans before radiotherapy,and they were divided into complete remission (CR) group and partial remission (PR) group according to BM results after radiotherapy; the local control rate (LCR) of CR group was significantly higher than that of PR group,but there was no significant difference in survival rate (SR) between the two groups.There were 65 patients who had no regional lymph node metastasis,and they were also divided into CR group and PR group according to BM results after radiotherapy;the LCR and SR of CR group were significantly higher than those of PR group.In summary,the patients who had a CR as evaluated by BM and had the maximal EWT of ≤ 1.20 cm and the volumes of residual lymph nodes of ≤ 1.00 cm3 on CT were defined as CR ; the patients who had a PR as evaluated by BM or had the maximal EWT of ＞ 1.20 cm or those who had a CR evaluated by BM and had the maximal EWT of ≤ 1.20 cm and the volumes of residual lymph nodes of ＞ 1.00 cm3 on CT were defined as PR.The cases evaluated by BM as no remission (NR) or showing metastasis were defined as NR or progressive disease.There were significant differences in LCR and SR between the CR group and PR group determined by the new criteria.Conclusions Simply using BM to evaluate the short-term radiotherapeutic effect on esophageal cancer has certain limitations; instead,the evaluation based on both BM and CT scans is more accurate.