三维技术放疗食管癌不同临床靶区的初步研究

目的 探讨食管癌淋巴引流区预防照射在根治性三维技术放疗中的价值,评价不同临床靶区照射后疗效及不良反应。方法 回顾分析2005—2010年间219例无远处转移的行根治性三维技术放疗的食管癌患者资料。105例接受累及野照射54~66 Gy;114例接受选择性淋巴引流区预防照射46~52 Gy,原发肿瘤局部处方剂量56~70 Gy。采用Kaplan-Meier法计算局部控制率和OS并Logrank法检验和单因素预后分析。结果 1、3、5年样本数分别为219、172、67例。累及野组与预防野组1、3、5年局部控制率分别为63.0%、39.1%、27.2%和70.5%、53.3%、51.7%(P=0.013),OS分别为67.6%、24.9%、15.0%和73.7%、45.1%、26.0%(P=0.025)。单因素分层分析显示病变部位为中下段、N₀期的局部控制率和OS预防野组明显高于累及野组(P=0.007、0.015和P=0.054、0.013)。结论 对于食管原发肿瘤位于胸中下段和无淋巴转移患者,预防性淋巴引流区照射后局部控制和长期生存均能获益。

A preliminary study of three-dimensional conformal radiotherapy with different clinical target volumes for esophageal cancer

Objective To investigate the value of prophylactic irradiation to the lymphatic drainage area in radical three-dimensional conformal radiotherapy (3DCRT) and to evaluate the efficacy and adverse effects of 3DCRT with different clinical target volumes. Methods A retrospective analysis was performed on the records of 219 esophageal cancer patients without distant metastasis who received 3DCRT from January 2005 to December 2010. One hundred and five patients received involved-field irradiation (IFI) with a total dose of 54—66 Gy;114 patients received elective nodal irradiation (ENI) with a total dose of 46—52 Gy;the prescribed dose to the primary lesion was 56—70 Gy. The Kaplan-Meier method was used to calculate local control (LC) and overall survival (OS) rates, and the log-rank test was used for univariate prognostic analysis. Results The 1-, 3-, and 5-year sample sizes were 219,172 and 67, respectively. The 1-, 3-, and 5-year LC rates for IFI group were 63.0%, 39.1%, and 27.2%, respectively, versus 70.5%, 53.3%, and 51.7% for ENI group (χ²=6.22, P=0.013);the 1-, 3-, and 5-year OS rates for IFI group were 67.6%, 24.9%, and 15.0%, respectively, versus 73.7%, 45.1%, and 26.0% for ENI group (χ²=5.04, P=0.025). The univariate stratified analysis showed that the LC and OS rates were significantly higher in the ENI group than in the IFI group for patients with middle-or lower-thoracic primary lesion or N₀ disease (P=0.007,0.015;P=0.054,0.013). Conclusions For esophageal cancer patients with middle-or lower-thoracic primary lesion or without lymph node metastasis, prophylactic irradiation to the lymphatic drainage area can increase LC and OS rates.