胸段食管鳞癌根治术后预防性放疗的范围

目的探讨胸段食管鳞癌根治术后预防性放疗的范围。方法回顾分析204例胸段食管鳞癌根治术后行预防性放疗患者的临床资料,其中仅照射纵隔(M)的26例,照射纵隔 双锁骨上(S)的139例,照射纵隔 胃左(L)的10例,3个区域全部照射的29例。Kaplan-Meier方法计算总生存率和无瘤生存率,Logrank检验组间差异,对可能影响预后的性别、年龄、肿瘤部位、长度、pT、pN和照射方式进行Cox回归模型分析。结果全组1、3、5年总生存率和无瘤生存率分别为83.8%、53.2%、34.1%和77.8%、51.6%、33.8%。不同照射方式的5年无瘤生存率分别为36.3%(M)、30.7%(M S)、40.0%(M L)和43.6%(M S L)(x~2=3.05,P=0.385)。多因素分析显示pT和pN为独立预后因素,而不同照射方式的组间差异无统计学意义(x~2=2.77,P=0.096)。46例上段和中上段(位于中段但侵犯上段)患者中,43例没有照射胃左的无一出现腹腔淋巴结转移;下段和中下段(位于中段但侵犯下段)是否照射双锁骨上的患者出现该部位淋巴结转移的比例分别为2%(1/ 43)和6%(1/18)(P=0.516)。结论上段和中上段患者似乎可不预防胃左,下段和中下段患者似乎可不预防双锁骨上。

Extent of postoperative prophylactic radiotherapy after radical surgery of thoracic esophageal squamous cell carcinoma

Objective To determine the extent of postoperative prophylactic radiotherapy after radi- cal surgery of thoracic esophageal squamous cell carcinoma.Should the entire mediastinum ( M ),bilateral supraclavicular areas (S) and the left gastric area (L) be all included in the irradiation field? Methods The clinical data of 204 such patients treated from 1996 through 1999 were retrospectively reviewed.They were classified into four groups:group A,26 patients given irradiation to the mediastinum M alone;group B,139 patients given irradiation to the mediastinum and bilateral supraclavieular areas M S;group C,10 patients irradiation to the mediastinum plus left gastric area M L;and group D,29 patients irradiation to all these three areas (M S L).The overall and disease-free survival rates were calculated using the Kaplan- Meier method and comparison of these groups was done with the Logrank test.Prognostic variables were en- tered into a Cox regression model controlling the age,gender,length,site,pT,pN,and treatment re- ceived.Results The 1-,3- and 5-year overall and disease-free survival rates of all 204 patients were 83.8%,53.2% ,34.1% and 77.8%,51.6% ,33.8%,respectively.The 5-year disease-free survival rates for patients in group A,group B,group C,and group D were 36.3%,30.7% ,40.0% and 43.6% (x~2=3.05,P=0.385 ),respectively.Multivariate analysis showed that the pT and pN were independent risk factors for disease-free survival rate,whereas treatment arm gave no significant difference (x~2=2.77,P =0.096).None of the 43 patents without irradiation to the L had abdominal lymph node metastasis from le- sions in the upper and upper-middle third( located middle third but invasion to the upper third) thoracic e- sophagus.The data of supraclavicular lymph node metastasis between patients with and without irradiation showed that S in lesion in the lower and middle-lower third (located middle third but invasion to the lower third) thoracic esophagus were 2% ( 1/43 ) and 6% (1/18) ( Fisher's Exact Tests ,P=0.516),respective- ly.Conclusions It seems that it is unnecessary to give irradiation to the L when the primary site is loca- ted in the upper or middle-upper third of thoracic esophagus who had received prophylactic postoperative ra- diotherapy after radical surgery.Similarly,the supraclavicular areas (S) may not need irradiation for lesion in the lower or middle-lower third.