适形放疗治疗食管癌腹膜后淋巴结转移疗效分析

目的探讨适形放疗食管癌腹膜后淋巴结转移的疗效。方法 33例食管癌伴腹膜后淋巴结转移患者,给予适形放疗,180～200cGy/f,80%～90%以上的等剂量线包括靶区,腹膜后总剂量36～60Gy。结果完全缓解（CR）率30.3%（10/33）、部分缓解（PR）率48.5%（16/33）,无变化（NC）＋进展（PD）率22.2%（7/33）,总有效率（CR＋PR）78.8%（26/33）。1,2,3年生存率分别为57.6%（19/33）、21.2%（7/33）和9.1%（3/33）。中位生存期18个月。单因素分析显示,放疗体积、症状缓解、放疗剂量、转移淋巴结大小、是否同时发病、是否伴有癌栓等对生存期有影响;多因素分析显示,放疗体积、症状缓解与生存情况有关,而放疗剂量、食管病变位置、转移淋巴结大小、是否同时发病、是否伴有癌栓等与生存情况无关。结论三维适形放疗治疗食管癌伴腹膜后淋巴结转移安全有效;放疗体积越小,效果越好。

Efficacy of conformal radiotherapy in the treatment of retroperitoneal lymph node metastasis of esophageal carcinoma

Objective To analyse the clinical efficacy of conformal radiotherapy in the treatment of retroperitoneal lymph node metastasis of esophageal carcinoma. Methods Thirty-three patients with retroperitoneal lymph node metastasis of esophageal carcinoma were treated with conformal radiotherapy in our department. The dose was 1. 8-2. 0 Gy per fraction five times a week,the retroperitoneal total dose ranged from 36 Gy to 60 Gy. The planned target volume was encompassed by more than 80% to 90% isodose line. Results The overall response rate（ CR ＋ PR） was 78. 8% . The 1,2,3-years survival rates were 57. 6% （ 19 / 33） ,21. 2% （ 7 /33） and 9. 1% （ 3 /33） . the median survival time was 18 months. The single factor analysis showed that the volume of radiotherapy,partial and complete response,radiotherapy dose,the size of metastatic lymph node,concomitant illness,tumor thrombi had influence on survival time. Multivariate analysis showed that the volume of radiotherapy,partial and complete response were related to survival condition, while radiotherapy dose,the site of esophageal lesion,the size of metastatic lymph node,concomitant illness and tumor thrombi were not related to the outcome. Conclusion Three-dimensional conformal radiotherapy is a safe and effective treatment for retroperitoneal lymph node metastasis of esophageal carcinoma. The less the radiotherapy volume,the better the response rate with conformal radiotherapy.