CAJ | 학술논문

目的：观察食管癌三维适形放疗长期疗效，并探讨影响因素。方法回顾性分析2003至2012年我院收治的食管鳞癌患者1349例，采用三维适形放疗(980例)及调强放疗(369例)，常规分割照射，中位处方剂量60Gy。放化疗433例，单纯放疗916例。 Kaplan-Meier并Logrank法计算局部控制率和生存率， Cox法多因素预后分析。结果随访率97．55%。①全组患者总有效率为99．0%，其中完全缓解50．5%，部分缓解48．5%，无缓解1．0%。②全组患者1、3、5年局控率分别为75．2%、54．5%、50．1%；1、3、5年生存率分别为68．6%、36．2%、24．5%，中位生存期21个月。③单因素预后分析显示性别、年龄、病变部位、近期疗效、是否行全身化疗及TNM分期、食管病变长度、CT最大横径、周围受侵、GTV体积均为预后相关因素。④多因素分析显示年龄、病变部位、是否化疗及GTV体积为食管癌三维适形放疗的独立预后因素。⑤放化疗组生存情况优于单放组，以同期放化优势更明显；颈、胸上段食管癌放疗疗效优于胸中、下段；放疗剂量以60~65Gy为宜。结论三维适形放疗治疗食管癌疗效确切；年龄、病变部位、是否化疗及GTV体积为食管癌三维适形放疗长期生存的独立预后因素；加入同期化疗可提高长期生存率，颈、胸上段食管癌放疗疗效优于胸中、下段，放疗剂量以60~65Gy为宜。
목적：관찰식관암삼유괄형방료장기료효，병탐토영향인소。방법회고성분석2003지2012년아원수치적식관린암환자1349례，채용삼유괄형방료(980례)급조강방료(369례)，상규분할조사，중위처방제량60Gy。방화료433례，단순방료916례。 Kaplan-Meier병Logrank법계산국부공제솔화생존솔， Cox법다인소예후분석。결과수방솔97．55%。①전조환자총유효솔위99．0%，기중완전완해50．5%，부분완해48．5%，무완해1．0%。②전조환자1、3、5년국공솔분별위75．2%、54．5%、50．1%；1、3、5년생존솔분별위68．6%、36．2%、24．5%，중위생존기21개월。③단인소예후분석현시성별、년령、병변부위、근기료효、시부행전신화료급TNM분기、식관병변장도、CT최대횡경、주위수침、GTV체적균위예후상관인소。④다인소분석현시년령、병변부위、시부화료급GTV체적위식관암삼유괄형방료적독립예후인소。⑤방화료조생존정황우우단방조，이동기방화우세경명현；경、흉상단식관암방료료효우우흉중、하단；방료제량이60~65Gy위의。결론삼유괄형방료치료식관암료효학절；년령、병변부위、시부화료급GTV체적위식관암삼유괄형방료장기생존적독립예후인소；가입동기화료가제고장기생존솔，경、흉상단식관암방료료효우우흉중、하단，방료제량이60~65Gy위의。
Objective To summarize the outcomes and prognositic factors of esophageal cancer patients treated with three-dimensional conformal radiotherapy. Methods 1349 patients with esophageal cancer received three dimensional conformal radiotherapy (980 cases with 3DCRT, 369 with IMRT) in our hospital from 2003 to 2012. The median radiotherapy dose was 60Gy. 916 patients received radiotherapy alone and 433 patients received chemotherapy and radiotherapy. The Kaplan-Meier method and the log-rank test was used to calculate the local control rate and overall survival. The Cox regression model was used for multivariate prognostic analysis. Results the follow-up rate was 97. 55%.①The total effective rate was 99%. The complete remission rate was 50. 5%, and partial remission 48. 5%, non remission 1%.②The 1,3,5 year local control rate and OS were 75. 2%, 54. 5%, 50. 1% and 68. 6%, 36. 2%,24. 5% respectively. The median survival time was 21 months.③Univariate a-nalysis showed that gender, age, tumor location , the short-term curative effect, chemotherapy , TNM stage, tumor length, maxi-mum diameter of CT, surrounding invasion and volume of GTV were prognostic factors.④Multivariate analysis indicated that age, tumor location , chemotherapy and volume of GTV were independent prognostic factors for OS.⑤The OS of chemoradiotherapy group was better than radiotherapy group, and the concurrent chemoradiotherapy group has more advantage. The OS of cervical and upper thoracic esophageal carcinoma was better than the middle and lower segment; The better radiation dose was 60 ~65Gy. Conclusion the effect of three-dimensional conformal radiotherapy for esophageal cancer was exact. The age, tumor location , chemotherapy and volume of GTV were independent prognostic factors for OS. With concurrent chemotherapy the OS can be im-proved. The OS of cervical and upper thoracic esophageal carcinoma was better than the middle and lower segment. The better radi-ation dose was 60~65Gy.