中华放射医学与防护杂志
中華放射醫學與防護雜誌
중화방사의학여방호잡지
Chinese Journal of Radiological Medicine and Protection
2015年
4期
274-279
,共6页
食管肿瘤%肿瘤复发,局部%放射疗法%预后
食管腫瘤%腫瘤複髮,跼部%放射療法%預後
식관종류%종류복발,국부%방사요법%예후
Esophageal neoplasms%Neoplasm recurrence,local%Radiotherapy%Prognosis
目的 探讨468例食管鳞癌术后局部区域复发患者三维适形调强放疗的疗效及相关预后因素.方法 回顾性分析468例食管鳞癌术后局部区域复发行放疗的患者资料,术后复发时间为2 ～ 252个月,中位数14.95个月.锁骨上区复发45例,纵隔复发291例,腹腔复发4例,吻合口复发15例,锁骨上区+纵隔复发89例,吻合口+纵隔复发11例,纵隔+腹腔复发7例,锁骨上区+吻合口复发1例,锁骨上区+腹腔复发2例,吻合口+纵隔+锁骨上区复发3例.经典三维适形放疗(3D-CRT)224例,调强放疗(IMRT) 244例.放疗剂量40～70 Gy(中位放疗剂量59.4 Gy).在166例联合化疗患者中,同步放化疗109例,序贯放化疗57例.Kaplan-Meier法计算生存率并Log-rank法检验和预后单因素分析,Cox法预后多因素分析.结果 随访率95.3％,总有效率为81.6％,其中CR为41.2％.术后局部区域复发放疗后1、2、3、4年生存率分别为61％、32％、21％和14％,中位生存期17.6个月.单因素分析显示年龄、术后病理分期、术后N分期、复发部位、病灶单或多发、病灶大小、近期疗效、放疗剂量、化疗与否与预后相关(x2 =4.814～247.322,P＜0.05);多因素分析显示年龄、术后病理分期、病灶单或多发、病灶大小、近期疗效、放疗剂量、化疗与否是独立预后因素(P＜0.05).术后局部区域复发放疗后患者死亡原因为局部及区域性复发致死176例,占死亡数的47.57％(176/370);远处转移148例,占40.00％(148/370);局部复发+远处转移为16例,占4.32％ (16/370);1例死于放射性肺炎;2例死于急性心肌梗塞;1例死于脑出血;原因不明26例(含失访).肺是最常见的远处转移部位.结论 食管鳞癌术后局部区域复发患者三维适形调强放疗可以延长部分患者生存时间,年龄小于70岁,术后分期较早,单个复发病灶,小病灶,放疗剂量≥59.4 Gy,足量放疗后缓解者,采取同步放化疗的患者预后较好.
目的 探討468例食管鱗癌術後跼部區域複髮患者三維適形調彊放療的療效及相關預後因素.方法 迴顧性分析468例食管鱗癌術後跼部區域複髮行放療的患者資料,術後複髮時間為2 ～ 252箇月,中位數14.95箇月.鎖骨上區複髮45例,縱隔複髮291例,腹腔複髮4例,吻閤口複髮15例,鎖骨上區+縱隔複髮89例,吻閤口+縱隔複髮11例,縱隔+腹腔複髮7例,鎖骨上區+吻閤口複髮1例,鎖骨上區+腹腔複髮2例,吻閤口+縱隔+鎖骨上區複髮3例.經典三維適形放療(3D-CRT)224例,調彊放療(IMRT) 244例.放療劑量40～70 Gy(中位放療劑量59.4 Gy).在166例聯閤化療患者中,同步放化療109例,序貫放化療57例.Kaplan-Meier法計算生存率併Log-rank法檢驗和預後單因素分析,Cox法預後多因素分析.結果 隨訪率95.3％,總有效率為81.6％,其中CR為41.2％.術後跼部區域複髮放療後1、2、3、4年生存率分彆為61％、32％、21％和14％,中位生存期17.6箇月.單因素分析顯示年齡、術後病理分期、術後N分期、複髮部位、病竈單或多髮、病竈大小、近期療效、放療劑量、化療與否與預後相關(x2 =4.814～247.322,P＜0.05);多因素分析顯示年齡、術後病理分期、病竈單或多髮、病竈大小、近期療效、放療劑量、化療與否是獨立預後因素(P＜0.05).術後跼部區域複髮放療後患者死亡原因為跼部及區域性複髮緻死176例,佔死亡數的47.57％(176/370);遠處轉移148例,佔40.00％(148/370);跼部複髮+遠處轉移為16例,佔4.32％ (16/370);1例死于放射性肺炎;2例死于急性心肌梗塞;1例死于腦齣血;原因不明26例(含失訪).肺是最常見的遠處轉移部位.結論 食管鱗癌術後跼部區域複髮患者三維適形調彊放療可以延長部分患者生存時間,年齡小于70歲,術後分期較早,單箇複髮病竈,小病竈,放療劑量≥59.4 Gy,足量放療後緩解者,採取同步放化療的患者預後較好.
목적 탐토468례식관린암술후국부구역복발환자삼유괄형조강방료적료효급상관예후인소.방법 회고성분석468례식관린암술후국부구역복발행방료적환자자료,술후복발시간위2 ～ 252개월,중위수14.95개월.쇄골상구복발45례,종격복발291례,복강복발4례,문합구복발15례,쇄골상구+종격복발89례,문합구+종격복발11례,종격+복강복발7례,쇄골상구+문합구복발1례,쇄골상구+복강복발2례,문합구+종격+쇄골상구복발3례.경전삼유괄형방료(3D-CRT)224례,조강방료(IMRT) 244례.방료제량40～70 Gy(중위방료제량59.4 Gy).재166례연합화료환자중,동보방화료109례,서관방화료57례.Kaplan-Meier법계산생존솔병Log-rank법검험화예후단인소분석,Cox법예후다인소분석.결과 수방솔95.3％,총유효솔위81.6％,기중CR위41.2％.술후국부구역복발방료후1、2、3、4년생존솔분별위61％、32％、21％화14％,중위생존기17.6개월.단인소분석현시년령、술후병리분기、술후N분기、복발부위、병조단혹다발、병조대소、근기료효、방료제량、화료여부여예후상관(x2 =4.814～247.322,P＜0.05);다인소분석현시년령、술후병리분기、병조단혹다발、병조대소、근기료효、방료제량、화료여부시독립예후인소(P＜0.05).술후국부구역복발방료후환자사망원인위국부급구역성복발치사176례,점사망수적47.57％(176/370);원처전이148례,점40.00％(148/370);국부복발+원처전이위16례,점4.32％ (16/370);1례사우방사성폐염;2례사우급성심기경새;1례사우뇌출혈;원인불명26례(함실방).폐시최상견적원처전이부위.결론 식관린암술후국부구역복발환자삼유괄형조강방료가이연장부분환자생존시간,년령소우70세,술후분기교조,단개복발병조,소병조,방료제량≥59.4 Gy,족량방료후완해자,채취동보방화료적환자예후교호.
Objective To study the effect of three dimensional conformal intensity modulated radiotherapy and prognostic factors for postoperative local recurrent esophageal squamous cell carcinomas.Methods A total of 468 patieuts with postoperative local recurrent esophageal squamous cell carcinomas were retrospectively analyzed.The median interval between surgery and recurrence was 14.95 months (2-252 months).There were 45 patients with supraclavicular lympy node relapse,291 with mediastinal lymph node relapse,4 with abdominal lymph node relapse,15 with anastomosis relapse,89 with supraclavicular and mediastinal lymph node relapse,11 with anastomosis and mediastinal lymph node relapse,7 with mediastinal and abdominal lymph node relapse,1 with supraclavicular and anastomosis relapse,2 with supraclavicular and abdominal lymph node relapse,3 with anastomosis,mediastinal and supraclavicular lymph node relapse.There were 224 patients who received three-dimensional conformal radiation therapy,and the other 244 patients of intensity-modulated radiation therapy,with a median dose of 59.4 Gy (40-70 Gy).A total of 166 patients received adjuvant chemotherapy.Kaplan-Meier method was used to calculate the survival rate;Log-rank test was used for univariate prognostic analysis;Cox regression test was used for multivariate prognostic analysis.Results The follow-up rate was 95.3％.The recent curative effect in the effective rate was 81.6％,with 41.2％ CR rate.The overall 1,2,3,4 years of survival rates after radiotherapy were 61％,32％,21％,14％ respectively and the median survival time was 17.6 months.Univariate analysis showed that age,.pathologic stage,the number of positive lymph node cleaning,the recurrence area,single or multiple lesions,the size of the lesion,overall response rate,radiation dose,and chemotherapy (x2 =4.814-247.322,P ＜ 0.05) were associated with prognosis.Multivariate analysis showed that age,pathologic stage,the recurrence area,single or multiple lesions,the size of the lesion,overall response rate,radiation dose,and chemotherapy (P ＜0.05) were independent prognostic factors.A total of 370 patients had progressive diseases after radiotherapy,176 had local failure 47.57％ (176/370),148 had distant metastasis 40.00％ (148/370) and 16 had both local and distant failures 4.32％ (16/370).One case died of pneumonia;2 cases died of acute myocardial infarction;1 case died of cerebral hemorrhage;26 cases died of unknown cause (including lost to follow-up).Lung was the most common distant metastatic site.Conclusions Radiotherapy may improve the survival of esophageal squamous cell carcinoma patients with postoperative recurrence.Patients with less than 70 years old,early postoperative stage,single recurrent lesion,initial small lesions,response to radiotherapy,radiation dose of higher than 59.4 Gy,chemoradiation might have better prognosis.
