局部晚期食管癌患者累及野照射联合化疗的疗效分析

目的分析局部晚期食管癌患者累及野照射联合化疗的失败模式及预后。方法回顾性分析2003-01-01-2009-01-01山东省肿瘤医院放疗科接受累及野放疗联合化疗的80例局部晚期食管癌患者,依据首次复发部位与治疗靶区,将失败模式分为照射野内复发、野外区域淋巴结复发和远处转移,并分析不同复发模式组的生存情况。结果治疗结束后80例患者治疗有效68例（85.00%）,达临床完全缓解（CR）19例（23.75%）,部分缓解（PR）49例（61.25%）。中位随访时间52.6个月（95%CI：46.1-56.7个月）,全组患者的中位生存时间（median survival time,MST）为14.4个月。共76例患者出现复发,其中野内复发43例（53.75%）,远处转移33例（41.25%）,野外区域淋巴结复发24例（30.00%）。有野内复发或远处转移的患者MST分别为14.2和13.2个月,均显著低于未出现者的17.4个月（P=0.01）和15.9个月（P〈0.001）,而出现野外区域淋巴结转移与未出现者MST均为14.5个月,差异无统计学意义,P=0.665。结论累及野放疗联合化疗治疗局部晚期食管癌,野内复发及远处转移为主要复发模式且影响生存,而野外区域淋巴结并未明显影响患者总生存期,其可行性有待多中心大样本前瞻性随机对照试验进一步证实。

Prognostic analysis of involved-field irradiation with chemotherapy in locally advanced esophageal carcinoma patients

OBJECTIVE This study is to observe the failure patterns and prognosis in patients with locally advanced esophageal carcinoma （EC） receiving involved-field irradiation （IFI） with chemotherapy. METHODS The retrospective study was preformed on the clinical records of 80 patients with locally advanced EC, who received IFI with chemotherapy between January 1,2003 and January 1,2009 in the Department of Radiation Oncology of Shandong Cancer Hospital. Comparing the target volume and first sites of failure, patterns of failure were defined as in-field, out-of-field regional lymph node and distant failure. The survival was calculated by different patterns of failure. RESULTS The median survival time （MST） of all the patients ineluded was 14.4 months （m）. With a median follow-up of 52.6 m, failures were observed in 76 patients. In-field recurrence, distant metastases and out-of-field regional failure were seen in 43 （53.75 %）, 33（41.25 %）, 24（30.00%） patients, respectively. There was significant difference in OS for patients with and without in-field （MST, 14.2 vs 17.4 m, P=0.01） or distant failure （13.2 vs 15.9 m, P〈0. 000 1）, but not for out-of-field regional lymph node failure （both 14.5 m, P=0. 665）. CONCLUSIONS In-field and distant failures, as the predominant failure patterns in advanced EC patients, affected the prognosis of patients significantly. But the incidence of regional failure did not result in a worse survival. Further investigation is needed to establish the optimal radiotherapy field for these patients at advanced stage.