钡餐造影结合CT评价食管癌放疗近期疗效的研究

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。

Evaluating short-term radiotherapeutic effect on esophageal cancer by barium meal combined with CT scans

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.