可手术切除食管癌单纯三维适形放疗失败原因分析

目的 分析可手术切除食管鳞癌患者单纯三维适形放疗(3DCRT)结果,为准确判断预后和取得更好疗效提供参考。
方法 回顾分析本院2002-2007年间92例根治性3DCRT食管癌患者治疗失败原因,Kaplan-Meier法计算复发、转移、局部控制、生存等,Cox法分析影响复发、转移的因素。
结果 总失败率为51%(47/92),失败原因中单纯区域性复发29例、单纯远处转移12例、远处转移伴区域性复发6例。区域性复发中胸中段食管癌高于胸上、下段食管癌(23、8、4例,χ²=39.36,P=0.000),部分缓解者高于完全缓解者(18、7例,χ²=23.44,P=0.000);远处转移中胸下段食管癌高于胸上中段食管癌(7、6、5例,χ²=14.42,P=0.001)。多因素分析结果显示N分期、临床分期和近期疗效为影响区域性复发因素;N分期、临床分期、病变X线长度和近期疗效为影响远处转移因素。
结论 单纯3DCRT后胸上段食管癌患者区域性复发率和远处转移率低于胸中下段食管癌患者,疗后达完全缓解者区域性复发率和远处转移率较低,临床分期仍是影响区域性复发和远处转移的重要因素。

Analysis of failure patterns of three-dimensional conformal radiotherapy alone in resectable esophageal cancer

Objective To analyse the outcome of patients with resectable esophageal squamous cell carcinoma after receiving three-dimensional conformal radiotherapy (3DCRT) alone, and to provide a reference for accurate prognosis prediction and better therapeutic effect. Methods A retrospective analysis was performed in 92 patients with esophageal cancer, who received radical 3DCRT in our hospital from February 2002 to July 2007, to determine the reasons for treatment failure. The recurrence, metastasis, local control, and survival were calculated by the Kaplan-Meier method;the influential factors for recurrence and metastasis were analyzed using the Cox model. Results The overall failure rate was 51%(47/92);of the 47 patients, 29 had regional recurrence, 12 had distant metastasis, and 6 had both distant metastasis and regional recurrence. In the patients with regional recurrence, there were more individuals with middle thoracic esophageal cancer than individuals with upper and lower thoracic esophageal cancers (23 vs 8 and 4, χ²=39.36,P=0.000), and there were more individuals with a partial remission than individuals with a complete remission (18 vs 7, χ²=23.44, P=0.000). In the patients with distant metastasis, there were more individuals with lower thoracic esophageal cancer than individuals with upper and middle thoracic esophageal cancers (7 vs 6 and 5, χ²=14.42, P=0.001). The multivariate analysis showed that N stage, clinical stage, and short-term efficacy were the influential factors for regional recurrence and that N stage, clinical stage, length of tumor on X-ray film, and short-term efficacy were the influential factors for distant metastasis. Conclusions After receiving 3DCRT alone, the patients with upper thoracic esophageal cancer have lower regional recurrence and distant metastasis rates than those with middle and lower thoracic esophageal cancers, and the patients with a complete remission have lower regional recurrence and distant metastasis rates than those with a partial remission. Clinical stage is still an important influential factor for regional recurrence and distant metastasis.