91例术后局部复发转移食管癌放疗疗效和预后分析

目的 探讨食管癌术后局部复发转移的放疗疗效和预后影响因素.方法 回顾性分析食管癌术后局部复发转移行放疗的91例患者资料,术后复发时间为1～35个月,中位数为11.1个月.吻合口复发4例,纵隔淋巴结转移+吻合口复发6例;腹腔淋巴结转移4例,锁骨上淋巴结转移20例,纵隔淋巴结转移34例,锁骨上区+纵隔淋巴结转移23例.常规放疗56例,三维适形放疗35例,剂量50～70 Gy.68例联合化疗1～4个周期.结果 随访率为95%.1、2、3年生存率分别为52%、20%和14%.Logrank单因素分析显示术后复发时间、术后临床分期、放疗剂量、近期疗效、术后T分期、术后N分期与预后相关(P=0.001、0.000、0.001、0.000、0.028、0.003).Cox多因素分析结果显示术后复发时间、术后临床分期、放疗剂量、近期疗效是独立预后因素(P=0.014、0.006、0.009、0.000).结论 食管癌术后局部复发转移患者放疗可以延长部分患者生存时间,术后复发时间长、术后分期早、放疗后近期疗效好、放疗总剂量≥60 Gy者预后较好.

Effect of radiotherapy on loco-regional recurrence of esophageal carcinoma after surgery

Objective To study the effect of radiotherapy and prognostic factors for patients with post-operative loco-regional recurrence of esophageal carcinoma. Methods From 2000 to 2005,91 patients with esophageal carcinoma who developed post-operative loco-regional recurrence were analyzed retrospectively. The interval between surgery and recurrence was 1 -35 months, with a median interval of 11.1 months. There were 4 patients with anastomosis relapse, 6 with anastomosis and mediastinal lymph nodes relapse,4 with abdominal lymph node relapse, 20 with supra-clavicular lymph node relapse, 34 with mediastinal lymph node relapse, and 23 with mediastinal and supra-clavicular lynph node relapse. There were 56 and 35 patients who received conventional and three-dimensional conformal radiation therapy respectively, with a total radiation dose of 50 -70 Gy. Sixty-eight patients received adjuvant chemotherapy.Results The follow-up rate was 95%. The 1-,2-and 3-year overall survival rates were 52%, 20% and 14%, respectively. In univariate analysis, the recurrence time (P = 0. 001), postoperative stage (P =0. 000), radiation dose (P =0. 001) ,overall response rate (P =0. 000) ,T stage (P =0. 028), and N stage (P = 0. 003) were related with prognosis. Multivariate analysis showed that the recurrence time (P =0. 014), postoperative stage (P = 0. 006), radiation dose (P = 0. 009), overall response rate (P = 0. 000)were independent prognostic factors for survival. Conclusions Radiotherapy may improve the survival of esophageal carcinoma patients with postoperative recurrence. Patients with long recurrence-free time, early stage, high response rates, and radiation dose of higher than 60 Gy have better prognosis.