脑转移瘤的X刀治疗与手术治疗疗效比较分析

目的 :探讨X刀在脑转移瘤治疗中的临床价值。方法 :回顾分析X刀治疗的 30例脑转移瘤患者 ( 4 1个病灶 ) ,脑转移瘤直径 ( 2 .0 7± 1.7)cm ,平均剂量 2 2Gy ,肿瘤中心剂量 ( 2 8± 8)Gy ,边缘剂量 ( 16± 4 )Gy。比较分析手术加全脑放射治疗 2 6例 ,直径 ( 3.0 7± 0 .7)cm ,平均放疗剂量 4 6Gy。结果 :X刀治疗组 1年生存率 53% ,手术加全脑放疗组 4 3% ,1年后局部肿瘤控制率分别为 83%和 75% ,1年后因神经系统疾患死亡率分别为 39%和 4 1%。结论 :X刀是一种安全、有效和微侵袭的治疗方法 ,适用于中小体积脑转移瘤的治疗     

磁共振成象对成人早期霍奇金病放射治疗疗效的评估价值

目的　测量 60例成人早期霍奇金病 (HD)放疗前后磁共振成像 (MRI)信号强度 (SI)的变化 ,标定放疗后肿瘤组织纤维化的程度 ,从而准确评估放疗对成人早期HD的疗效。方法　应用MRI的自动测量系统 ,在放疗前后分别测量肿瘤、皮下脂肪及肌肉的SI ,分别用脂肪和肌肉的SI除以肿瘤的相应测量值而得到标准化值。结果　放疗后肿瘤SI的脂肪和肌肉的标准化值的均数及标准差分别为 0 .4± 0 .3和 1.8± 1.2 ,比放疗前的标准化值明显减小 (P值 <0 .0 1)。结论　MRISI的测量可准确评估成人早期HD的放疗效果 ,其T2 加权图像 (T2 WI)可对纤维组织和残留或复发的肿瘤组织作出鉴别。     

大鼠放射性损伤后肠黏膜一氧化氮浓度和组织结构变化的研究

目的 :研究大鼠急性放射性肠炎后小肠黏膜一氧化氮 (nitricoxide ,NO)浓度与平均绒毛数和绒毛高度变化的关系。方法 :实验用雄性Wistar大鼠 2 4只 ,分为 2组。肠炎组 (照射组 )大鼠用 6MV X线腹部单次照射 ,剂量为 11Gy。对照组 (未照射组 )为正常对照。实验第 4天处死动物 ,剥下小肠黏膜制成 10 %匀浆 ,测定NO浓度 ;另取 2cm小肠制作组织病理切片后在光镜下测量肠黏膜每厘米长度的平均绒毛数量和绒毛高度。结果 :对照组和肠炎组小肠NO浓度分别为 (0 2 2± 0 13) μmol g和 (0 6 0±0 35 ) μmol g ,对照组的NO浓度显著低于肠炎组 (P <0 0 5 ) ;对照组与肠炎组的组织病理学相比较 ,每厘米平均绒毛数分别为 (6 3± 5 )个 cm和 (2 2± 3)个 cm (P <0 0 0 1) ,平均绒毛高度为 (0 2 4± 0 0 3)mm和 (0 0 7± 0 0 2 )mm ,肠炎组平均绒毛数量和绒毛高度都非常显著地减少 (P <0 0 0 1)。结论 :小肠放射性损伤后肠组织中NO浓度是显著升高的     

适形放疗与常规放疗结合治疗Ⅲ期肺鳞癌疗效分析

自 1996年 10月 -2 0 0 0年 10月对 118例Ⅲ期肺鳞癌常规放射治疗 40～ 5 0Gy(平均 44 6Gy)后的残留病灶再行适形放疗。肿瘤边缘单次处方剂量平均为 6 8Gy ,间隔 1～ 2d ,总照射剂量平均为 39 4Gy。肿瘤靶体积 (GTV) 0 8cm3～ 14 8 6cm3,平均 36 6cm3,计划靶体积 (PTV ) 3 6cm3～ 2 13 5cm3,平均 5 1 4cm3。近期肿瘤退缩率分别为CR30 5 % ( 36 118)、PR 5 3 4% ( 63 118)、NR 11 9% ( 14 118)和PD 4 2 % ( 5 118) ,总有效率 (CR +PR ) 83 9%。 1、2、3年生存率分别为 68 6% ( 81 118)、35 6% ( 31 87)和 12 2 % ( 6 49) ,局部控制率分别为 92 4% ( 10 9 118)、85 1% ( 74 87)和79 6% ( 39 49)。急性放射性肺炎Ⅰ～Ⅱ级 2 7 1% ( 32 118) ,Ⅲ级 3 4% ( 4 118) ,Ⅳ级 0 ( 0 118)。急性放射性食管炎Ⅰ～Ⅱ级 16 1% ( 19 118) ,Ⅲ～Ⅳ级 0 ( 0 118)。骨髓抑制Ⅰ～Ⅱ级 9 3% ( 11 118) ,Ⅲ～Ⅳ级 0 ( 0 118)。晚期放射性食管反应Ⅲ级 1例 ,放射性肺损伤Ⅱ级 1例。结果说明 ,对Ⅲ期肺鳞癌常规放疗后再行适形放疗局部加量照射 ,患者可耐受 ,疗程短 ,提高肿瘤控制率 ,延长生存期 ,是局部剂量升级的有效方法     

四维CT量化膈顶运动准确性和放疗前后呼吸运动稳定性临床验证

目的验证四维CT(4DCT)信息能否代表呼吸运动的实际情况,患者放疗前后呼吸活动是否有明显变化而影响4DCT在放疗中的应用。方法67例胸部肿瘤患者在GE discovery 16-slice PET/CT上行4DCT扫描,在AW 4.2 4D Advantage Sim 6.0工作站设计放疗计划。模拟机透视下观察放疗前后的呼吸频率、左右膈肌运动幅度、因呼吸不平稳导致膈肌运动超出4DCT测定范围的次数(脱靶率),比较呼吸频率和左右膈肌运动幅度在4DCT重建和模拟机透视下的差异。结果67例中58例能够重建出呼吸运动,其中32例放疗前后进行模拟机透视。放疗前后透视下呼吸频率和左右膈肌运动幅度的差异无统计学意义(P>0.100);4DCT重建与透视观察的呼吸频率差异无统计学意义(P>0.100);放疗前后脱靶率的差异有统计学意义(P<0.05);4DCT重建与透视下左右膈肌运动幅度的差异有统计学意义(P<0.05)。结论胸部肿瘤患者放疗前后呼吸状态基本一致,稳定性好;4DCT重建图像与患者呼吸保持一致性,但可能会遗漏部分信息。     

放疗参考点在平板床和非平板床CT片中变化的研究

目的 :比较体内某参考点在平板床和非平板床CT片上的变化情况。方法 :选择 36例同时摄平板及非平板床CT片的成人胸部肿瘤患者 ,测量两种条件下CT片上前后径、体内参考点到前、后表面正中的距离。结果 :两种条件下 (平板床与非平板床 )CT片上前后径、前径及后径差值均数分别为 :(0 82± 0 5 8)cm ,95 %CI[0 84 36 ,0 2 80 8];(0 5 6± 0 4 3)cm ,95 %CI[0 5 487,0 12 4 4];(0 5 0± 0 4 1)cm ,95 %CI[0 4 2 30 ,0 0 0 2 0 ]。 3组数据经自身配对t检验差异均有显著意义 ,t值分别为 4 0 5 6、3 196、2 2 35 ,P值分别为 0 0 0 0 3、0 0 0 31、0 0 316。结论 :用CT片制定放射治疗计划时应充分考虑平板床与非平板床的差异。     

PET用于勾画生物靶区的呼吸运动体模研究

目的测量不同运动频率和不同运动幅度下,用PET影像勾画GTV的大小,探讨不同运动状态对PET影像中病灶体积的影响。方法使用自行研制的二维运动平台系统及体模,模拟不同频率及幅度的呼吸运动,在不同运动状态下对体模进行PET-CT扫描,利用PET图像勾画GTV并计算其大小。结果静止状态下GTV(GTV0)为(7.90±0.21)cm3,运动频率为16次/min、18次/min及20次/min状态下GTV分别为(11.56±2.62)cm3(GTV16)、(12.51±3.57)cm3(GTV18)及(11.86±3.27)cm3(GTV20)。GTV0、GTV16、GTV18及GTV20之间差异有统计学意义,P均<0.01。z轴方向运动幅度为1.0、1.5及2.0cm状态下GTV分别为(11.44±3.68)cm3(GTVz-1.0)、(11.64±3.47)cm3(GTVz-1.5)、(12.83±2.02)cm3(GTVz-2.0)。x轴方向运动幅度为0.5、1.0及1.5cm状态下GTV分别为(9.68±2.32)cm3(GTVx-0.5)、(14.41±3.19)cm3(GTVx-1.0)、(11.83±1.92)cm3(GTVx-1.5)。在z轴和x轴运动方向上,各GTV差异有统计学意义。结论不同呼吸频率和运动幅度对PET图像勾画靶区均会产生较大影响,在采用PET影像制定放疗计划时建议采取门控技术等有效措施尽量减少这种影响,使得到的生物靶区尽可能地接近靶区的实际情况。     

后程立体定向放射治疗放疗后局部复发鼻咽癌--附42例临床分析

探讨立体定向放射治疗在鼻咽癌放疗后复发再程放疗中的价值。常规外照射组 2 0例 ,全程外照射 ,DT5 5～ 60Gy/5～ 6周。立体定向放射治疗后程加量组 2 2例 ,先常规外照射 ,DT3 0～ 40Gy/3～ 4周 ,后程立体定向放射治疗加量 ,DT3 5～ 4Gy/次 ,隔日 1次 ,共 4～ 6次。治疗后 3～ 6个月CT或MRI复查 :常规外照射组局部控制率为65 % ( 13 /2 0 ) ,后程加量组为 86 4% ( 19/2 2 ) ;新增张口受限及新增颞叶损伤常规组分别为 75 % ( 12 /16)、75 %( 9/12 ) ,后程加量组分别为 3 7 5 % ( 6/16)、3 0 8% ( 4 /13 )。初步研究结果提示 ,立体定向放射治疗对鼻咽癌放疗后复发再程放疗较常规外照射的局部控制率高 ,放射损伤小 ,患者生存质量高     

立体定向放射治疗肺癌脑转移疗效分析

目的探讨不同放射治疗方法对肺癌脑转移的疗效.方法176例由病理学证实的肺癌脑转移患者分为4组:单纯全脑放疗(WBRT)组、全脑放疗加立体定向放射外科(WBRT SRS)组、单纯立体定向放射治疗(SRT)组、全脑放疗加立体定向放射治疗(WBRT SRT)组.SRS治疗单次靶区平均周边剂量8～20Gy,总剂量20～32Gy;SRT治疗单次靶区平均周边剂量2～5Gy,总剂量25～60Gy;WBRT1.8～2Gy/次,总剂量30～40Gy.结果四组的局部控制率分别为47.0%、87.7%、86.5%和78.0%;中位生存期分别为5.0,11.0,11.5和10.0个月;局部无进展生存期分别为3.33,8.33,9.33和7.67个月;颅脑无新病灶生存期分别为4.11,8.57,9.03和6.12个月.在死因分析中,WBRT组死于脑转移的比率为57.6%,较其他三组高.而WBRT SRS组的晚期放射反应的发生率为12.2%,较其他组高.结论肺癌单发脑转移瘤患者的最佳治疗方式是单纯立体定向放射治疗,治疗失败后再行挽救性全脑照射或立体定向放疗.对于多发脑转移,全脑放疗加立体定向放射治疗(WBRT SRT)在提高生存率以及减少并发症方面优于其他治疗方法.     

143例脑胶质瘤立体定向加常规放疗的疗效观察

目的采用立体定向放疗与常规放疗结合治疗胶质瘤,分析其疗效并探讨其影响预后的因素。方法对143例脑胶质瘤患者采用立体定向放疗与常规放疗相结合方法。立体定向放疗针对GTV追加剂量,5～7 Gy/次,共5～7次。常规放疗主要针对亚临床病变,一般剂量为50Gy。寿命表法统计生存率。结果全组患者治疗3～6个月后KPS评分为81±9,与术前的71±9比较有明显改善(t=5．98,P＜0．01)。CR 39例(27．3%),PR 70例(49．0%),NC 25例(17．5%),PD 9例(6．3%),有效率为76%。1、3、5年生存率分别为56．6%、36．0%和21．7%。预后因素分析结果显示低分级胶质瘤的患者预后好,而年龄、肿瘤部位、治疗剂量等因素与预后无关。结论立体定向放疗加常规放疗治疗胶质瘤既发挥了放射物理剂量分布的优点,又符合放射生物学原则,较以往治疗提高了患者的生存机会。     

食管癌靶区运动的相关研究

The research of esophageal target is a difficult spot in the precise radiotherapy and the target mobility has an important effect for the radiotherapy of esophageal cancer. By different breathing control techniques, controlling the patient's respiratory may narrow target mobility so as to improve the accuracy of radiotherapy. But the present studies of the movement range of esophageal cancer with the respiratory control technologies have not come to a consistent standard. The area shape and position change of esophageal cancer target is a key problem that needs to be solved in the esophageal precise radiotherapy.     

Validation of supervised automated algorithm for fast quantitative evaluation of organ motion on magnetic resonance imaging

PURPOSE: To validate a correlation coefficient template-matching algorithm applied to the supervised automated quantification of abdominal-pelvic organ motion captured on time-resolved magnetic resonance imaging. METHODS AND MATERIALS: Magnetic resonance images of 21 patients across four anatomic sites were analyzed. Representative anatomic points of interest were chosen as surrogates for organ motion. The point of interest displacements across each image frame relative to baseline were quantified manually and through the use of a template-matching software tool, termed "Motiontrack." Automated and manually acquired displacement measures, as well as the standard deviation of intrafraction motion, were compared for each image frame and for each patient. RESULTS: Discrepancies between the automated and manual displacements of > or =2 mm were uncommon, ranging in frequency of 0-9.7% (liver and prostate, respectively). The standard deviations of intrafraction motion measured with each method correlated highly (r = 0.99). Considerable interpatient variability in organ motion was demonstrated by a wide range of standard deviations in the liver (1.4-7.5 mm), uterus (1.1-8.4 mm), and prostate gland (0.8-2.7 mm). The automated algorithm performed successfully in all patients but 1 and substantially improved efficiency compared with manual quantification techniques (5 min vs. 60-90 min). CONCLUSION: Supervised automated quantification of organ motion captured on magnetic resonance imaging using a correlation coefficient template-matching algorithm was efficient, accurate, and may play an important role in off-line adaptive approaches to intrafraction motion management.     

Evaluation of image-guidance strategies in the treatment of localized prostate cancer

PURPOSE: To compare different image-guidance strategies in the alignment of prostate cancer patients. Using data from patients treated using daily image guidance, the remaining setup errors for several different strategies were retrospectively calculated. METHODS AND MATERIALS: The alignment data from 74 patients treated with helical tomotherapy were analyzed, resulting in a data set of 2,252 fractions during which a megavoltage computed tomography image was used for image guidance with intraprostatic metallic fiducials. Given the daily positional adjustments, a variety of protocols, differing in imaging frequency and method, were retrospectively studied. The residual setup errors were determined for each protocol. RESULTS: As expected, the systematic errors were effectively reduced with imaging. However, the random errors were unaffected. Even when image guidance was performed every other day with a running mean of the previous displacements, residual setup errors>5 mm occurred in 24% of all fractions. This frequency increased to about 40% if setup errors>3 mm were scored. CONCLUSION: Setup errors increased with decreasing frequency of image guidance. However, residual errors were still significant at the 5-mm level, even with imaging was performed every other day. This suggests that localizations must be performed daily in the set up of prostate cancer patients during a course of external beam radiotherapy.     

The position and volume of the small bowel during adjuvant radiation therapy for rectal cancer

Purpose: The rate of small bowel toxicity from adjuvant pelvic radiation therapy (RT) for rectal cancer has been reported to be lower for patients treated preoperatively (Preop). This was probably due to a lesser volume of irradiated small bowel; however, studies of postoperative treatment reported that patients with an abdominoperineal resection (APR), who likely have the largest volume of small bowel in the pelvis, had less acute and chronic toxicity than those with a low anterior resection (LAR). In this study, three-dimensional treatment planning techniques were used to characterize the position and volume of small bowel in the pelvis and compare these to repeat studies obtained during the typical 5-week course of treatment to attempt to explain the above observations.

Methods and Materials: Treatment planning CT scans were obtained in 30 patients with rectal cancer (10 Preop, 10 LAR, 10 APR), including 12 patients with weekly CT scans during RT (65 scans). The position of the small bowel was measured by the distance to the nearest small bowel from the bones of the posterior pelvis and by the volume of small bowel within four anatomically defined regions of the pelvis. The motion of the small bowel was expressed as the standard deviation of the small bowel position measured with both the distance and the volume in the 12 patients with repeat studies.

Results: Contrast-containing small bowel was found an average 2.9 cm more anterior than small bowel without contrast below the sacral promontory. The position of the small bowel in Preop patients was significantly more anterior (p ≤ 0.01) with less volume (p ≤ 0.04) in the pelvis than postoperatively treated patients. The small bowel was also more anterior for patients with an LAR vs. APR (p ≤ 0.03) but with similar volume in all pelvic regions. Small bowel motion, expressed as the standard deviation of the distance from the bones of the posterior pelvis to the closest small bowel, was 2.9 cm, 1.4 cm, and 0.2 cm for the Preop, LAR, and APR group, respectively. The LAR group had a considerable degree of motion in the posterior pelvis. Increased bladder volume was associated with reduced small bowel volumes, although this benefit decreased during treatment.

Conclusion: Because treatment planning CT scans can detect small bowel that does not contain contrast, they may be more accurate than the traditional small bowel series. The Preop patients had significantly less pelvic small bowel supporting the clinical observation of better tolerance to therapy. The higher small bowel toxicity reported for LAR vs. APR patients may be explained by the greater variability of both the position and volume of the small bowel in the posterior pelvis for LAR patients. This finding suggests that a single planning study may not be accurate for the block design used for boost treatment of LAR patients. Bladder-filling techniques were useful for Preop and LAR but not APR patients, and decreased in benefit over time. This study suggested that treatment planning CT scans were more useful than a small bowel series and that more than one treatment planning CT may be obtained in any patient receiving > 45 Gy for rectal cancer. However, further research will be necessary to determine the optimal timing and total number of repeat studies.     

Feasibility of fully automated detection of fiducial markers implanted into the prostate using electronic portal imaging: a comparison of methods

PURPOSE: To investigate the feasibility of fully automated detection of fiducial markers implanted into the prostate using portal images acquired with an electronic portal imaging device. METHODS AND MATERIALS: We have made a direct comparison of 4 different methods (2 template matching-based methods, a method incorporating attenuation and constellation analyses and a cross correlation method) that have been published in the literature for the automatic detection of fiducial markers. The cross-correlation technique requires a-priory information from the portal images, therefore the technique is not fully automated for the first treatment fraction. Images of 7 patients implanted with gold fiducial markers (8 mm in length and 1 mm in diameter) were acquired before treatment (set-up images) and during treatment (movie images) using 1MU and 15MU per image respectively. Images included: 75 anterior (AP) and 69 lateral (LAT) set-up images and 51 AP and 83 LAT movie images. Using the different methods described in the literature, marker positions were automatically identified. RESULTS: The method based upon cross correlation techniques gave the highest percentage detection success rate of 99% (AP) and 83% (LAT) set-up (1MU) images. The methods gave detection success rates of less than 91% (AP) and 42% (LAT) set-up images. The amount of a-priory information used and how it affects the way the techniques are implemented, is discussed. CONCLUSIONS: Fully automated marker detection in set-up images for the first treatment fraction is unachievable using these methods and that using cross-correlation is the best technique for automatic detection on subsequent radiotherapy treatment fractions.     

全碳素纤维治疗床对吸收剂量的影响

目的 研究放疗中新型全碳素纤维治疗床对患者剂量的影响.方法 利用0.6 cm3电离室和PTW二维电离室矩阵分别在空气和模体中测量6、10、18 MV X线穿过治疗床的透射因子.在固体水中利用二维电离室矩阵测量治疗床对吸收剂量的影响,以及吸收剂量随斜入射角度和空气间隙的变化.结果 180°后野照射时,在最大剂量点,5、10 cm深度,治疗床对吸收剂量的影响都在5%以内.治疗床对吸收剂量的影响与斜入射角度及空气间隙有关.在模体内5 cm深度处随斜入射角度的增加而变大,而空气间隙的变化对吸收剂量的影响很小.插板比主体床板薄,对吸收剂量的影响比主体床板小.结论 全碳素纤维治疗床对整个治疗靶区的吸收剂量有一定影响,并且随斜入射角度和空气间隙而变化.治疗计划设计时需要考虑治疗床对吸收剂量及其分布的影响,     

An international review of patient safety measures in radiotherapy practice

Errors from radiotherapy machine or software malfunction usually are well documented as they affect hundreds of patients, whereas random errors affecting individual patients are more difficult to be discovered and prevented. Although major clinical radiotherapy incidents have been reported, many more have remained unrecognised or have not been reported. The literature in this field is limited as it is mostly published as a result of investigation of major errors. We present a review of radiotherapy incidents internationally with the aim of identifying the domains where most errors occur through extensive review and synthesis of published reports, unpublished ‘Grey literature’ and departmental incident data. Our review of radiotherapy-related events in the last three decades (1976-2007) identified more than seven thousand (N = 7741) incidents and near misses. Three thousand one hundred and twenty-five incidents reported patient harm of variable intensity ranging from underdose increasing the risk of recurrence, to overdose causing toxicity, and even death for 1% (N = 38); 4616 events were near misses with no recognisable patient harm. Based on our review, a radiotherapy risk profile has been published by the WHO World Alliance for Patient Safety that highlights the role of communication, training and strict adherence to guidelines/protocols in improving the safety of radiotherapy process.     

MRI-based tumor motion characterization and gating schemes for radiation therapy of pancreatic cancer

Background and purpose

To characterize pancreatic tumor motion and to develop a gating scheme for radiotherapy in pancreatic cancer.

Materials and methods

Two cine MRIs of 60 s each were performed in fifteen pancreatic cancer patients, one in sagittal direction and one in coronal direction. A Minimum Output Sum of Squared Error (MOSSE) adaptive correlation filter was used to quantify tumor motion in craniocaudal, lateral and anteroposterior directions. To develop a gating scheme, stability of the breathing phases was examined and a gating window assessment was created, incorporating tumor motion, treatment time and motion margins.

Results

The largest tumor motion was found in craniocaudal direction, with an average peak-to-peak amplitude of 15 mm (range 6–34 mm). Amplitude of the tumor in the anteroposterior direction was on average 5 mm (range 1–13 mm). The least motion was seen in lateral direction (average 3 mm, range 2–5 mm). The end exhale position was the most stable position in the breathing cycle and tumors spent more time closer to the end exhale position than to the end inhale position. On average, a margin of 25% of the maximum craniocaudal breathing amplitude was needed to achieve full target coverage with a duty cycle of 50%. When reducing the duty cycle to 50%, a margin of 5 mm was sufficient to cover the target in 11 out of 15 patients.

Conclusion

Gated delivery for radiotherapy of pancreatic cancer is best performed around the end exhale position as this is the most stable position in the breathing cycle. Considerable margin reduction can be established at moderate duty cycles, yielding acceptable treatment efficiency. However, motion patterns and amplitude do substantially differ between individual patients. Therefore, individual treatment strategies should be considered for radiotherapy in pancreatic cancer.     

Tomographie par émission de positons (TEP) pour la radiothérapie : technique et innovations

Multimodal imaging has become a standard for planning radiation therapy via magnetic resonance imaging (MRI) or positron emission tomography (PET) in many cancers. However, its use is now old, and its impact has not been much discussed in light of technological improvements in imaging and advances in radiotherapy. However, in 20 years, the exclusive functional imaging has been replaced by hybrid imaging (functional and anatomical) with successive improvements (flight time, detector modifications, digitisation, etc.) have enabled us to go from centimetric resolution to the current 3 to 4 mm resolution. This article will specifically review PET technology, its latest advances and the potential impact on radiotherapy, particularly head and neck cancers.     

术后辅助3DRT改善pT2－3N0M0期食管癌患者长期生存

目的 评价3DRT (3DCRT、IMRT)在pT_2－3N₀M₀期胸段食管鳞癌根治术后辅助治疗中的临床价值。方法 分析2004—2011年本院入组pT_2－3N₀M₀期胸段食管鳞癌根治术后3DRT前瞻性非随机Ⅱ期临床研究的96例及同期全部单纯手术820例患者的复发、生存及放疗不良反应。Kaplan-Meier法计算生存率并Logrank检验,Cox模型预后多因素分析。结果 术后放疗组T₃期、肿瘤长度≥5 cm患者比例显著高于单纯手术组。术后放疗、单纯手术组5年样本数分别为35、270例。术后放疗、单纯手术组5年OS率分别为74.3%、59.9%(P=0.010),5年DFS率分别为71.0%、51.7%(P=0.002)。多因素分析显示术后放疗是影响OS、DFS的因素(P=0.030、0.004)。术后放疗组和单纯手术组总复发率、LRR率、远处转移率分别为22.9%和43.0%(P=0.000)、18.8%和35.2%(P=0.001)、11.5%和21.3%(P=0.024)。术后放疗组25例(26.0%)发生3级早晚期不良反应。结论 辅助3DRT较单纯手术降低了pT_2－3N₀M₀期胸段食管鳞癌术后复发率,提高了5年DFS、OS且不良反应反应可耐受,但还需前瞻性Ⅲ期随机研究证实。