食管癌加速超分割放射治疗的研究进展

放射治疗是食管癌主要治疗手段之一，但食管放疗的疗效一直不能令人满意，随着加速超分割放射治疗技术的完善和进展，食管癌放疗的疗效和生存率有了明显的提高，现综述食管癌加速超分割的生物学基础、应用技术以及副反应等方面的研究进展。     

放射治疗结合中西医治疗中晚期食管癌临床分析

放射治疗是中晚期食管癌主要治疗手段之一，常规放射治疗疗效一直无明显提高，而合理的综合治疗可以提高疗效。我院自1994年5月至1996年11月对196例中晚期食管癌患者随机分组治疗，现将结果报道如下。     

食管癌加速超分割放射治疗的研究进展

放射治疗是食管癌主要治疗手段之一，但食管癌放疗的疗效一直不能令人满意，随着加速超分割放射治疗技术的完善和进展，食管癌放疗的疗效和生存率有了明显的提高，现综述食管癌加速超分割的生物学基础、应用技术以及副反应等方面的研究进展。     

食管癌三维适形放射治疗

三维适形放射治疗是目前我国临床运用广泛的精确放射治疗方式之一，尤其近10年来，三维适形放射治疗在提高局控率和生存率方面取得了长足进步。本文对近5年来国内多家医院食管癌三维适形放射治疗方法进行综述，介绍目前食管癌三维适形放射治疗在剂量以及分割方式、适应症选择以及并发症控制、单一的三维适形放射治疗以及多种治疗手段的综合运用上存在不同的见解。     

老年食管癌患者放疗疗效及相关临床因素分析

目的 探讨老年食管癌患者放射治疗的近远期疗效及其影响因素。方法 回顾性分析哈尔滨医科大学附属第三医院70例自2001年1月—2007年12月间以放疗为主要治疗手段,年龄≥70岁的老年食管癌患者的近期疗效,1、2、3年生存率及其相关临床因素和毒副反应的耐受情况。结果 放疗后总有效率为88.5%。1、2、3年总生存率及无病生存率分别是62.28%和10.80%、27.51%和7.20%、13.89%和3.40%。单因素及多因素分析显示,影响生存期的主要因素为病变的长度、治疗前转移情况(P＜0.05)。急性放射性肺反应、急性放射性食管反应及骨髓抑制发生率分别为24.3%、64.3%和48.6%。结论 放射治疗老年食管癌患者近期疗效显著,耐受性好;影响其生存期的主要因素是治疗前病灶长度及是否有转移。     

食管支架植入术加放疗治疗中晚期食管癌疗效观察

目的观察食管支架植入术后加放疗治疗中晚期食管癌疗效。方法对34例中晚期食管癌患者置放钛镍合金支架,然后放疗。结果食管支架置入后解除和缓解了吞咽困难,放射治疗延长了患者的生存期,1、3年生存期分别为79．4％（27／34）和5．9％（2／34）。结论食管支架置入加放射治疗是治疗中晚期食管癌的有效手段。     

三维适形放疗联合多西紫杉醇同期化疗治疗84例老年食管癌

目的:探讨三维适形放射治疗联合多西紫杉醇同期化疗治疗老年食管癌的疗效和毒副作用.方法:84例老年食管癌患者随机分成A组和B组,A组40例采用三维适形放射治疗,总剂量50Gy~64Gy/25次~32次,5周~7周完成.B组44例采用三维适形放射治疗联合多西紫杉醇25mg/m2/周同期化疗.结果:两组患者的无进展生存期分别...     

立体定向放射治疗食管癌术后纵隔淋巴结转移

目的探讨胸段食管癌根治术后纵隔淋巴结转移的治疗方法，观察立体定向放射治疗食管癌术后纵隔淋巴结转移的疗效。方法对16例食管癌根治术后发生纵隔淋巴结转移患者应用立体定向放射治疗，照射剂量45～55Gy。结果16例1、2年生存率分别为81．3％(13／16)、43．7％(7／16)。结论食管癌根治术后发生纵隔淋巴结转移进行立体定向放射治疗安全有效，可以延长患者生存时间。     

食管癌放射治疗进展

我国是食管癌高发国家,年新发病例占世界各国新发病例一半以上。预测至2000年我国每年死于食管癌的人数将超过19万人[1]。放射治疗是中晚期食管癌的主要治疗手段。食管癌确诊时,每100例中只有20例能根治切除,其余80例主要依靠放射治疗或（和）其他治疗相结合的综合治疗。而根治切除的病例,40％发生局部复发后仍将依靠放射治疗。常规分割放疗80％病例局部病灶未控制或复发,5年生存率大多不超过10％,提高放疗局控率是提高食管癌疗效的关键,也是目前食管癌治疗研究的重要课题之一。1提高放射治疗剂量以最小的放射剂量达到最大的肿瘤杀灭…     

70岁以上老年食管癌的放射治疗

我科选择70岁以上老年食管癌患者60例行放射治疗，收到了良好的效果。总结报道如下。1临床资料1.1一般资料     

Treatment of esophageal cancer in elderly patients

During the last 30 years, the median survival time and 5-year survival rate of esophageal cancer have improved significantly. In recent years, two major factors have greatly contributed to improve the outcomes of treatment for esophageal cancer in Japan. One is the establishment of endoscopic diagnosis and treatment of superficial esophageal cancer, and another is the establishment of a standard surgical procedure, subtotal esophagectomy with dissection of three field lymph nodes. In an aging society like Japan, with the increased incidence, the diagnosis and treatment of esophageal cancer will become increasingly important in the future. The effectiveness and risk of surgical treatment, chemotherapy, radiotherapy and combination therapy for elderly patients with esophageal cancer will also become important. However, the average life expectancy has reached 79 years for Japanese men, and various evidence from clinical research on patients less than 75 years old is not longer sufficient. Care of elderly patients with esophageal cancer has relied on past experience. Now, clinical studies on elderly esophageal cancer must be improved.     

老年食管癌的治疗选择

伴随着社会老龄化趋势的加剧,老年食管癌患者的比例在不断增加。鉴于老年患者的手术耐受性较差、合并症多等原因,放疗在老年食管癌的治疗中显得尤为重要。本文主要探讨老年食管癌综合治疗进展。     

不可手术老年食管癌的放疗进展

食管癌在中国发病率高,死亡率在癌症死亡率中常年居于第四位。在老龄化社会中,老年食管癌患者数量持续增加。然而,由于并发症多、一般行为评分低、治疗耐受性差等临床特点,很多研究将老年食管癌患者排除在外。尽管在过去的几十年中,食管癌预后有所改善,但老年食管癌的治疗效果并不理想。这需要联合现有治疗手段并结合新的治疗方式。文中分析了放疗及放疗联合化疗、靶向治疗或免疫治疗在不可手术老年食管癌患者中的疗效及不良反应。     

老年食管癌手术前后生存质量的临床研究

目的　探讨老年食管癌切除手术前后生存质量的变化情况。方法　收集老年组（n＝４０）与非老年组（ｎ＝４０）食管癌切除手术患者,通过ＱＬＱ-Ｃ３０和ＱＬＱ-ＯＥＳ１８量表对手术前后行生存质量调查。结果　术后２５天,老年组ＱＬＱ-Ｃ３０各项生存质量指标与治疗前基线状态相比基本恢复,与非老年组比较,无显著性差异;而老年组ＱＬＱ-ＯＥＳ１８中进食、梗阻、食欲减退、咳嗽等指标较非老年组显著降低,吞咽困难显著升高,于治疗４０天,两组指标无显著性差异。结论　老年食管手术前后生存质量通用量表ＱＬＱ-Ｃ３０评分的变化与非老年组患者相近,而食管癌专用量表ＱＬＱ-ＯＥＳ１８中部分指标的恢复较非老年患者需要更长的时间。     

Esophagectomy compared with chemoradiation for early stage esophageal cancer in the elderly

BACKGROUND:

Esophagectomy has been the traditional treatment of choice for early stage esophageal cancer. However, esophagectomy is associated with high mortality and morbidity in the elderly, and these patients often receive chemoradiation instead. The authors of this report compared outcomes of esophagectomy versus chemoradiation in a population‐based sample of elderly patients with early stage esophageal cancer.

METHODS:

The Surveillance, Epidemiology, and End Results‐Medicare database was used to identify patients aged ≥65 years who were diagnosed with stage I or II esophageal cancer from 1991 to 2002. The associations of treatment with esophagectomy or chemoradiation were assessed along with demographic and clinical variables. A survival analyses was performed to compare outcomes with treatment modality and was adjusted for potential confounders.

RESULTS:

Seven hundred thirty patients with stage I or II esophageal cancer were identified who underwent esophagectomy (n = 341; 46.7%) or chemoradiation (n = 389; 53.3%). Older age, squamous cell histology, and lower socioeconomic status were associated with increased odds of receiving chemoradiation. In multivariate analyses, chemoradiation was associated with worse disease‐specific survival (hazard ratio [HR], 2.08; 95% confidence interval [CI], 1.64‐2.64) and overall survival (HR, 1.92; 95%CI, 1.58‐2.34). The receipt of chemoradiation was associated with worse survival for patients with adenocarcinoma (HR, 3.01; 95%CI, 2.24‐4.04), but there was no significant difference for patients with squamous cell carcinoma (HR, 1.33; 95%CI, 0.98‐1.80).

CONCLUSIONS:

Compared with chemoradiation, esophagectomy may be associated with improved survival for early stage esophageal cancer in the elderly. The current results suggest that there also may be a subset of patients with squamous cell carcinoma for whom chemoradiation is adequate therapy. A randomized trial would be useful to determine the optimal treatment for elderly patients with early stage esophageal cancer. Cancer 2009. © 2009 American Cancer Society.     

Esophagitis and cancer of the esophagus

Early diagnosis is an important factor in the effort to increase the healing rates of esophageal cancer; another consideration is the establishment of a reliable method of identifying risk groups. Alcohol abuse is known to be associated with a higher risk of esophageal cancer. The current investigation, based on a retrospective study of the records of patients with esophageal cancer, reveals a strong connection between cancer development and chronic esophagitis due mainly to reflux in about 10% of the patients. In the literature this connection has been suspected but never so clearly shown. The clinical implication may be a more rigorous approach to long-standing esophagitis in elderly patients.     

70岁以上老年人食管癌放射治疗疗效观察

 自1983 年1 至1993 年3 月,我院放射治疗70 岁以上老年人（ 老年） 食管癌46 例,其中Ⅲ、Ⅳ期病人占82-6 % ,伴发病多达47-8 %.全组1 、3 、5 年生存率分别为45-7 % 、22-7% 、11-9 %.初步结果表明：放射治疗对老年食管癌患者是一种安全、有效的治疗方法。同时应注意伴发病的治疗。     

Patterns of care study of radiation therapy for esophageal cancer in Japan: influence of age on parameters of treatment

Background. In Japan, the elderly population is growing rapidly, and therefore, so is the number of cancer patients who are not good candidates for aggressive surgery or chemotherapy. Radiation therapy offers excellent potential for the treatment of such patients, with minimal invasion and functional preservation. A Patterns of Care Study (PCS) examined the parameters of treatments used for patients with esophageal cancer to determine nationwide variations by age. Methods. From July 1996 through February 1997, external nationwide PCS audits were performed for 29 institutions. Medical charts were reviewed for 455 patients with thoracic esophageal cancer treated between 1992 and 1994. The parameters of treatments used for these patients were compared between those aged 75 years (elderly; n = 113) and those aged <75 years (yourger; n = 342). Results. Surgery was used in 49% of the younger group and in 17% of the elderly group (P < 0.0001) while chemotherapy was used in 48% of the younger and 24% of the older group (P < 0.0001). The ratio of non-surgery group with radiation therapy increased significantly from 49% to 82% (P < 0.0001). Approximately 70% of the non-surgery patients received an external radiation dose of more than 60Gy, even in the elderly (P = 0.3001). Preliminary results showed no significant difference in survival between the two age groups (P = 0.5559). Conclusions. The use of radiation therapy in elderly people with esophageal cancer has increased markedly. The PCS provided important information about variations in radiotherapy parameters in patients with esophageal cancer in relation to age. Such information should be useful for future prospective studies of the elderly.     

Differences in treatment and survival between elderly patients with thoracic esophageal cancer in metropolitan areas and other areas

To address the major issue of regional disparity in the treatment for elderly cancer patients in an aging society, we compared the treatment strategies used for elderly patients with thoracic esophageal cancer and their survival outcomes in metropolitan areas and other regions. Using the national database of hospital-based cancer registries in 2008-2011, patients aged 75 years or older who had been diagnosed with thoracic esophageal cancer were enrolled. We divided the patients into two groups: those treated in metropolitan areas (Tokyo, Kanagawa, Osaka, Aichi, Saitama, and Chiba prefectures) with populations of 6 million or more and those treated in other areas (the other 41 prefectures). Compared were patient backgrounds, treatment strategies, and survival curves at each cancer stage. In total, 1236 (24%) patients from metropolitan areas and 3830 (76%) patients from nonmetropolitan areas were enrolled. Patients in metropolitan areas were treated at more advanced stages. There was also a difference in treatment strategy. The 3-year survival rate among cStage I patients was better in metropolitan areas (71.6% vs. 63.7%), and this finding mainly reflected the survival difference between patients treated with radiotherapy alone. For cStage II-IV patients, there were no differences. Multivariable Cox proportional hazard analysis including interaction terms between treatment areas, cStage, and the first-line treatments revealed that treatments in the metropolitan areas were significantly associated with better survival among patients treated with radiotherapy alone for cStage I cancer. Treatment strategies for elderly patients with thoracic esophageal cancer and its survival outcomes differed between metropolitan areas and other regions.