食管癌精确放疗的研究进展

目的:总结食管癌精确放疗的国内外研究进展,为临床治疗提供依据.方法:应用PubMed和CNKI等数据检索系统及数据库,以“食管癌、放射治疗”等为关键词检索2000-01-2011-10的相关文献,纳入标准:1)四维CT、正电子发射计算机/断层显像(PET/CT)在食管癌精确放疗中的应用及靶区勾画研究进展;2)不同食管癌精确放疗计划的剂量学比较;3)食管癌精确放疗的分割方式及疗效评估.根据纳入标准分析文献36篇.结果:四维CT及PET/CT在食管癌精确定位及靶区勾画中得到很好的应用,三维适形放疗/调强化疗(3DCRT/IMRT)治疗提高了食管癌患者的局部控制率及近期生存率.Rapid Arc具有靶区剂量适形度高,剂量分布均匀性好,减少总机器跳数和减少治疗时间等优势.改变放疗方式利用3DCRT后程加速超分割比常规分割疗效略有提高,但急性放疗反应加重,晚期反应的发生率未增加.结论:食管癌精确放疗仍以3DCRT/IMRT为主,Rapid Arc技术虽然有较好的优越性,但是临床应用前景需要进一步研究.     

全量放疗后复发性食管癌的外科治疗

目的:探讨全量放疗后食管癌复发的外科手术治疗的可行性。方法:回顾性分析从1995年1月至2004年12月76例全量放疗后复发的食管癌施行外科手术治疗的临床资料。结果:手术切除率86.0%,并发症40.8%,死亡率17.1%。切除组术后1,3,5年生存率分别为63.1%、23.7%、14.5%。结论:对全量放疗后复发性食管癌行外科手术是可行的,但手术适应症应严格掌握。     

老年食管鳞癌根治性放化疗疗效观察及预后分析

背景与目的：随着人口的老龄化,≥70岁老年食管癌患者越来越多,然而对这部分患者的研究资料并不多,本研究评价老年食管鳞癌患者根治性放化疗疗效及相关预后因素。方法：回顾性分析2009年3月—2011年12月在复旦大学附属肿瘤医院放疗科接受根治性放化疗的年龄≥70岁的食管鳞癌初治患者治疗疗效及相关预后因素。结果：共53例符合条件的患者,中位年龄74岁;单纯放疗患者29例,同期放化疗患者24例;1、2、3和5年生存率分别为62%、44%、33%和19%;2度及以上急性放射性食管炎及放射性肺炎发生率分别为6%和9%,无一例患者发生4度及以上放射性损伤。COX多因素分析显示,治疗方式、病变部位以及吸烟史与患者的预后明显相关。结论：放疗能为老年食管鳞癌患者所耐受,是一种安全的治疗方式,同期化疗的参与能够提高患者治疗的疗效。     

A STUDY OF ENDOSCOPIC TREATMENT OF ADVANCED ESOPHAGEAL AND GASTRIC CARCINOMA

Ｔｈｅｌｉｆｅｑｕａｌｉｔｙｏｆｇａｓｔｒｉｃａｎｄｅｓｏｐｈａｇｅａｌｃａｎｃｅｒｐａｔｉｅｎｔｓｗｅｒｅｖｅｒｙｐｏｏｒｗｈｅｎｔｈｅｒｅｗｅｒｅｒｅｃｕｒｅｎｃｅｌｅｓｉｏｎａｆｔｅｒｏｐｅｒａｔｉｏｎａｎｄｒａｄｉｏｔｈｅｒａｐｙ，ｅｓｐｅｃ...     

影响食管癌单纯放疗后一年生存率的因素

目的:分析影响食管癌单纯放疗一年生存的因素,为个体化治疗方案制定和准确评估预后提供参考标准。方法:回顾分析71例食管癌单纯放疗患者的临床资料,分析其一年生存率及影响因素。结果:所有患者在放疗结束后均随访一年以上。影响因素有X线所显示病变之长度、放疗剂量、CT所示肿瘤最大直径、食管病变部位、血红蛋白水平以及是否合并淋巴结转移。而性别、年龄与预后无关。结论:食管癌X线所示病变越长,近期疗效越差;照射剂量≥50Gy者疗效优于<50Gy,>70Gy并不能提高疗效;CT最大直径越大预后越差;胸上中段疗效好于胸下段癌;血红蛋白正常者疗效优于血红蛋白低者;无淋巴结转移患者预后优于合并淋巴结转移患者。     

顺铂联合5-FU化疗同步放疗治疗食管癌的临床效果

目的:探讨顺铂联合5-FU化疗同步放疗治疗食管癌的临床效果.方法:选取2010年7月-2012年6月在本院住院治疗的经组织病理学确诊的食管癌患者85例.根据放化疗方案随机分为同步放化疗组和放疗组,比较两组患者治疗后近期疗效、发生转移、局部复发率和不良反应发生率的差异.比较两组患者治疗后随访3年中位生存时间的差异.结果:同步放化疗组总的有效率(35例,87.50％)高于放疗组(31例,68.89％),差异具有统计学意义(P＜0.05).同步放化疗组患者在治疗后发生转移4例(10.0％),低于放疗组的13例(28.89％),且差异具有统计学意义(P＜0.05).同步放化疗组治疗后放射性食管炎(29例,72.50％)高于放疗组(21例,46.67％)(P＜0.05).同步放化疗组治疗后发生Ⅰ级放射性肺炎7例(17.50％),放疗组发生5例(11.11％);同步放化疗组发生血液毒性26例(60.50％),放疗组发生24例(53.33％).两组患者的放射性肺炎和血液毒性发生率的差异均无统计学意义(P＞0.05).所有患者经对症处理后均可耐受不良反应且不影响治疗进程.同步放化疗组患者的3年随访中位生存期26个月显著高于放疗组患者的19个月(log-rank P ＜0.001).结论:顺铂联合5-FU化疗同步放疗治疗食管癌在不增加其不良反应的同时,明显提高了疗效.     

食管癌术后放疗的疗效分析

目的　评价食管癌术后放疗的价值。方法　 1990～ 1992年 ,行根治性切除胸段食管癌 97例 ,其中单纯手术 49例 ,术后放疗 48例 ,同时合并化疗 10例。结果　单纯手术与术后放疗和/或化疗的 2年局部控制率分别为 5 9%和 89% ,5年生存率为 19%和 2 5 %。2年局部控制率术后放疗组显著高于手术组 (P<0 .0 1)。 5年生存率术后放疗虽优于单纯手术组 ,但差异无显著性 (P>0 .0 5 )。结论　术后放疗是提高食管癌局部控制率的重要手段。     

食管癌放射敏感性相关基因及分子标志物研究进展

放疗是食管癌最主要的治疗手段之一,而放疗抵抗是食管癌放疗面临的最大困扰和障碍。放射敏感性是当今肿瘤放射生物学研究的重点和难点。多种基因可影响食管癌的放射敏感性,如果能筛选出放射敏感性的决定性基因,对于研究放射增敏、靶向治疗和预测放疗效果指导个体化治疗等具有重要意义。本文将从不同的信号转导通路入手就以往研究中食管癌放射敏感性相关的主要基因及重要分子标志物作一综述。     

Diagnosis and Treatment of Esophageal Neoplasms

During the last 10 years, the diagnosis and treatment of esophageal carcinoma have improved considerably. Endoscopy with Lugol staining and endoscopic ultrasonography have been newly introduced and used for early diagnosis and more accurate tumor staging. As a result, the number of patients with tumors at an early stage has increased remarkably (superficial carcinoma, 23%). In the field of treatment, surgical results have improved not only in the short term (30-day mortality rate, 4%) but also in the long term (5-year survival rate, 30%). The field of operation has been extended (3-fieId lymph node dissection), with lower morbidity and mortality. On the other hand, some techniques for limited treatment such as endoscopic mucosal resection, intraluminal radiotherapy, and laser irradiation have been introduced for the treatment of esophageal carcinoma at an early stage with curative intent. However, there are still many patients with esophageal carcinoma at an advanced stage for whom these treatments fail or are futile. The role of radiotherapy has been made more significant by the introduction of brachytherapy or in combination with other treatment modalities such as surgery, chemotherapy and hyperthermia. Response rates for existing anticancer drugs used as a single agent are 0-38%. Chemotherapy appears to have created significant improvements when used in combined modalities (response rate, 16-76%). However, chemotherapy for patients with esophageal carcinoma still offers an unsatisfactory survival benefit and remains experimental. Studies to evaluate multimodality treatments using chemotherapy, combined with radiotherapy and/or surgery have started. The contribution of molecular biology to the diagnosis and treatment of this disease is a subject for future investigation.     

后程三维适形放射治疗食管癌的临床研究

目的：评价后程三维适形放射治疗食管癌的疗效。方法：从2003年5月-2005年5月，对70例经病理证实的食管癌患者随机分为对照组和治疗组各35例。对照组采用3个野等中心常规分割，总剂量70Gy，35分次，7周完成。治疗组前程照射方法同对照组，剂量40Gy，20分次，4周完成；后程采用三维适形照射3Gy／次，10分次，2周完成；总剂量70Gy，30分次，6周完成。结果：治疗组和对照组的近期有效率分别为88．6％和77．1％（P〈0．05），1、3年局控率分别为77．1％、57．1％和62．9％、31．4％（P〈0．05），1、3年生存率分别为68．6％、42．9％和54．3％、25．7％（P〈0．05）。两组毒副反应的差异无统计学意义。结论：三维适形放疗食管癌的近、中期结果优于常规方法，急性毒副反应无明显差别。     

外照射联合锎－252腔内放疗在食管癌放疗后复发患者中的应用

目的：分析食管癌放疗后复发患者应用再程外照射放疗联合锎－252腔内放疗的价值。方法：选择2011年5月至2014年5月符合纳入标准的食管癌放疗后复发患者60例,分为实验组（外照射＋腔内）30例和对照组（单纯外照射）30例。比较两组患者近期缓解率、前2年生存率和不良反应。结果：实验组与对照组治疗结束后,患者近期缓解率分别为86．2％（25／29）和75．0％（21／28）,有统计学差异（P＜0．05）;治疗组第1、2年生存率分别为24．1％和21．4％,无明显统计学差异（P＞0．05）;两组患者不良反应发生情况比较实验组的不良反应主要表现为放射性食管炎和食管穿孔,对照组表现为放射性肺炎的发生率提高。结论：外照射联合锎－252腔内放疗可以提高食管癌放疗后局部复发患者的局控率,同时食管穿孔的风险增大。     

食管癌内科治疗及综合治疗进展

食管癌的综合治疗已日益受到临床的重视,放疗、化疗、手术三者的结合是食管癌综合治疗的趋势,合理而有效的综合治疗,已取得较单一方法更为满意的疗效,提高了患者的长期生存率。新的化疗药物的应用、对新辅助化疗的认识、和对辅助性化疗的再认识是食管癌内科治疗领域近年来发展的亮点。本文综述了近年来相关重要文献和临床试验,对食管癌的内科治疗和综合治疗进展作一介绍和述评,尤其是在疗效、生存率和不良反应等方面。     

艾迪注射液配合放射疗法治疗食管癌临床疗效观察

目的:比较艾迪注射液加放疗与单纯放疗对食管癌的近期疗效及不良反应。方法:艾迪组43例放疗同期采用艾迪注射液60m l溶于5%葡萄糖注射液500m l中,静脉滴注,每天一次,疗程21天;对照组42例单纯放疗。结果:艾迪组近期有效率为79.1%,对照组为71.4%,统计学上差别无显著性(P>0.05),胃肠道及血液学不良反应,艾迪组均明显低于对照组(P<0.05)。结论:艾迪注射液配合放疗能有效降低食管癌放疗的不良反应。     

Estimation of an optimal radiotherapy utilization rate for gastrointestinal carcinoma: a review of the evidence

BACKGROUND: Radiotherapy utilization rates for cancer vary widely, both within and between countries. The optimal proportion of patients with gastrointestinal malignancies who should receive at least one course of radiotherapy at some time during their illness is an important benchmark. METHODS: The authors studied treatment guidelines and treatment reviews to identify the indications for radiotherapy for patients with gastrointestinal malignancies. Optimal radiotherapy utilization trees were constructed to show the clinical attributes of patients with gastrointestinal carcinomas who will benefit from radiotherapy. Epidemiologic incidence data for each of these clinical attributes were obtained to calculate the optimal proportion of all patients with gastrointestinal malignancies for whom radiotherapy was considered appropriate. Optimal rates of radiotherapy use were compared with actual rates in population-based studies to assess any discrepancies between actual and optimal radiotherapy utilization rates. RESULTS: Radiotherapy was indicated in 80% of patients with esophageal carcinoma, 68% of patients with gastric carcinoma, 57% of patients with pancreatic carcinoma, 13% of patients with carcinoma of the gallbladder, 0% of patients with hepatic carcinoma, 14% of patients with colon carcinoma, and 61% of patients with rectal carcinoma. The actual radiotherapy utilization rates for most of these gastrointestinal malignancies fell well short of optimal rates, which were derived from evidence-based treatment guidelines. CONCLUSIONS: It is possible to model optimal radiotherapy utilization using published treatment guidelines and existing incidence data. There was a discrepancy between the optimal and actual rates of radiotherapy utilization for patients with carcinomas of the esophagus, stomach, pancreas, and rectum. Strategies to implement evidence-based clinical guidelines are recommended.     

食管癌组织VEGF表达的临床意义

目的：探讨血管内皮生长因子（VEGF）蛋白表达对食管癌术后放疗疗效的影响。方法：回顾性研究1999～2001年期间95例有临床随访资料的食管癌术后患者，应用免疫组化方法检测食管癌石蜡切片中VEGF蛋白的表达情况，选取45例根治术后行辅助放疗，选同期单独手术的50例患者作对照，应用Kaplan—Meier法和Cox比例风险模型进行分析。结果：VEGF在食管癌组织中阳性表达主要位于肿瘤细胞胞浆内，其VEGF蛋白表达阳性率为58．9％；VEGF蛋白表达与性别、年龄、病理类型、临床分期之间无明显相关性（P〉0．05），但与复发及远处转移呈正相关（P〈0．05）；在单纯手术组和术后放疗组中VEGF阳性表达和阴性表达的生存率差异有统计学意义（P〈0．05）；Cox多因素分析结果显示，治疗分组、分期和VEGF表达均为预测食管癌预后的独立指标。结论：VEGF蛋白表达是预后好差的指标之一，VEGF蛋白表达阳性者较阴性者对放疗不敏感，其高表达提示预后不良。     

前程超分割加后程加速超分割放射治疗食管癌的临床观察

目的观察前程超分割、后程加速超分割放射治疗食管癌的临床效果.方法前程超分割每次DT 110 cGy,2次/d,5 d/周,30～40 Gy/2.5～3.5周;后程加速超分割DT 145～150 cGy/次,2次/d,5 d/周,至总量DT 60～70 Gy/4.5～5周,两次照射间隔时间≥6 h.行常规分割放疗者设为对照组.结果前程超分割加后程加速超分割组与常规分割组的有效率及1年生存率分别为83.8%、70.9%和70.0%、46.7%,两组比较差异有显著性(P＜0.05).前程超分割加后程加速超分割组放射性食管炎较对照组重,但能耐受.结论前程超分割加后程加速超分割放射治疗食管癌,与常规放疗相比,疗程短、疗效高,可显著提高食管癌局部控制率和1年生存率.     

Clinical features of esophageal cancer in the octogenarian treated by definitive radiotherapy: a multi-institutional retrospective survey

BACKGROUND: As age-related infirmity often influences treatment options and outcome of esophageal cancer, the optimization of treatment for the elderly, especially in octogenarians, has been the subject of considerable debate. METHODS: We performed a retrospective, multi-institutional survey to assess the effect of age on the outcome of definitive radiotherapy for esophageal cancer by a questionnaire sent to eight institutions in Japan. RESULTS: There were 362 evaluable replies. The patients included 317 males and 45 females, with a median age of 72 years (range 35-93 years), and 96% had squamous cell carcinoma. There were 30 clinical stage 1, 71 stage IIA, 17 stage IIB, 113 stage III and 116 stage IV cases. The stage was not specified in 16 cases. Multiple co-morbidities existed in 40% of the patients who were 70 years of age or older. There was no statistically significant age-related difference in the incidence of adverse reactions to radiotherapy (P > 0.05). Overall survival was more significantly affected by Karnofsky Performance Status than by the patient's age. The influence of performance status on cumulative survival for stage I and II disease was more pronounced in patients in their 80s. CONCLUSION: The safety of radiotherapy for esophageal carcinoma is not influenced by the patient's age. Because the performance status strongly influenced survival, the multi-disciplinary assessment of functional status is mandatory for optimizing the choice of treatment for patients in their 80s with esophageal cancer.      

放疗联合化疗治疗食管癌90例临床效果观察

 目的 比较单纯放疗和放疗联合化疗治疗食管癌的治疗效果。方法 将90例食管癌随机分成对照组及综合治疗组。两组均采用三野放疗，200 cGy／次，总剂量6 400～6 800 cGy，综合治疗组先行卡铂（CBP）、5-氟尿嘧啶（5-Fu）、羟喜树碱（HCPT）方案化疗，再行放疗。结果 综合治疗组局部控制率及1，3年生存率均高于对照组（P＜0.05），综合治疗组急性胃肠道反应、骨髓抑制较对照组严重（P＜0.05），两组晚期并发症差异无统计学意义（P＞0.05）。主要晚期副作用是放射性食管狭窄和肺纤维化。结论 综合治疗组能显著提高食管癌局部控制率与生存率，急性毒性增加，晚期反应无明显增加。     

Survival and esophageal passage after radiotherapy of inoperable esophageal carcinoma. A retrospective study of 106 cases

Survival and esophageal passage were studied retrospectively in 106 patients with inoperable esophageal carcinoma treated with radiotherapy during the years 1972 to 1983. The survival rates were 30%, 13% and 7% at one, two and three years respectively. The survival rate for the female patients was significantly better than for the males throughout these three years; 9% of the female patients lived for three years compared to only 3% of the male patients. Forty-two percent of the patients received 'radical' irradiation (greater than 50 Gy). The 3-year survival rate was 16% after a tumor dose of 50 Gy or more, and zero with a dose less than 50 Gy, but this difference might be explained by selection factors, such as patients in poor general condition not receiving 'radical' irradiation. Esophageal passage after radiotherapy could be evaluated in 62 patients, and 22 (35%) of them required feeding gastrostomy due to esophageal discontinuity, most often within one year after completion of radiotherapy. It is concluded that radiotherapy has only a slight effect on the prognosis of inoperable esophageal carcinoma.     

下咽及颈段食管鳞癌的治疗

目的：研究下咽及颈段食管鳞癌的治疗效果。方法：回顾性分析117例初治下咽及颈段食管鳞癌不同治疗方法的效果。结果：总3年生存率为60．0％，术前放疗原发灶达到完全缓解与非完全缓解者3年生存率分别为82.0%、45.0%。术后发生并发症27例（23．1％）。死亡47例，其中局部复发未控15例（31．9％），颈部复发未控11例（23．4％），远处转移6例（12．8％）。术前放疗喉功能保留率为46．3％，而单纯手术或术后放疗者为27．3％。结论：术前放疗为主的综合治疗可提高下咽颈段食管鳞癌的生存率及喉功能的保留率；术前放疗完全缓解者生存率较高。局部复发与颈部淋巴结转移是下咽颈段食管癌的主要死亡原因。