792例食管癌三维技术放疗的疗效分析

目的 观察食管鳞状细胞癌三维技术放疗的局部控制率及生存率,并探讨影响因素。方法 回顾分析2003—2008年收治的食管癌患者 792例,采用三维适形放疗(672例)及调强放疗(120例)技术,1.8~2.0 Gy/次,5 次/周,处方剂量 50~70 Gy。同期放化疗 142例,单纯放疗 650例。Kaplan-Meier法计算局部控制率和生存率,Logrank法单因素预后分析,Cox法多因素预后分析。结果随访率为95.8%,随访时间满 5年者 133例。全组1、3、5年局部控制率分别为76.6%、53.2%、48.6%,总生存率分别为70.1%、36.7%、28.0%。单因素预后分析显示T分期、N分期、临床分期、肿瘤体积为影响生存的因素(χ²=20.58~55.60,P均=0.000),多因素预后分析显示N分期、肿瘤体积为影响生存的因素(χ²=6.35、29.23,P=0.012、0.000)。同期放化疗与单纯放疗的 5年局部控制率分别为57.0%和46.8%(χ²=7.34,P=0.007),5年总生存率分别为32.8%和27.6%(χ²=3.42,P=0.064)。结论 三维技术放疗食管癌的远期疗效较二维技术放疗明显提高。T分期、N分期、TNM分期、肿瘤体积是长期生存影响因素。加入同期化疗可提高患者的局部控制率。

Treatment outcomes of 792 cases of esophageal carcinoma patients treated with three-dimensional radiotherapy

Objective To investigate the long term clinical result of three-dimensional radiotherapyfor esophageal carcinoma, discuss the effect of correlative factors to survival and local control. MethodsFrom July 2003 to December 2008, 792 patients with esophageal cancer were eligible. Patients were treated with three-dimensional radiotherapy (672 patients) or intensity-modulated (120 patients) radiotherapy. The radiotherapy was delivered in 1.8－2.0 Gy per fraction, 5 fractions per week, total dose of 50－70 Gy,(median, 60 Gy). 142 patients were treated by concurrent radiochemotherapy, and the other 650 patients radiotherapy alone. The local control rate and survival rate were calculated by Kaplan-Meier method. Logrank method was used for univariate analyses. Cox regression model was used for multivariate analyses. Results The follow-up rate was 95.8%.The number of patients with 5 years time followed-up was 133.The 1-year, 3-year and 5-year local control rates were 76.6%, 53.2%, 48.6%, and the 1-year, 3-year and 5-year overall survival rates were 70.1%, 36.7% and 28.0%, respectively. There were significant influence on the prognosis of T stage, N stage, TNM stage, tumor volume (χ²=20.58－55.60,all P=0.000). The Cox multivariate model showed that N stage and tumor volume were independent prognostic factors (χ²=6.35,29.23,P=0.012,0.000). For the two groups of concurrent chemo-radiotherapy and radiotherapy alone, 5-year local control rates were 57.0% and 46.8%(χ²=7.34,P=0.007),the 5-year overall survival rate 32.8% and 27.6%(χ²=3.42,P=0.064. Conclusions Three-dimensional radiotherapy is effective for esophageal carcinoma. It might improve the local control rate and overall survival rate to some extent. T staging, N staging, TNM staging and tumor volume were important prognostic factors for long-term survival. The addition of concurrent radiochemotherapy could improve local control rates.