食管癌锁骨上淋巴结转移放射治疗的疗效和预后因素分析

目的:探讨食管癌锁骨上淋巴结转移放疗后的疗效和预后因素。方法:接受放射治疗的食管癌锁骨上淋巴结转移患者共64例,中位随访34个月(3~80个月)。其中食管癌治疗后锁骨上淋巴结转移33例,治疗时发现31例。所有锁骨上转移淋巴结患者均行常规分割放射治疗,总剂量为36~70Gy/5~7周,1·8~2·0Gy/d;其中单纯放疗组43例,放疗联合化疗组16例,放疗联合热疗5例。结果:在锁骨上淋巴结放射治疗结束时23例(35·9%)达CR;30例(46·9%)达PR。全组患者中位生存期13·5个月,最长随访时间80个月。1、3和5年生存率分别为56·3%、9·4%和3·1%。随访结束时37例(57·8%)患者死亡,无病生存患者15例(23·4%),7例患者带瘤生存(10·9%),5例失访。多因素分析显示,锁骨上转移淋巴结的直径(P=0·001)、单侧还是双侧(P=0·015)和转移的数目(P=0·042)对其放射治疗后能否达到CR差异有统计学意义;但对于生存率只有淋巴结的直径差异有统计学意义,P=0·010。结论:在食管癌治疗后发现锁骨上淋巴结转移的患者给予进一步的治疗仍能获得一定的治疗效果,采用综合治疗并未提高患者的长期生存率。

Clinical analysis of radiotherapy for esophageal carcinoma with supraclavicular lymph node metastasis

OBJECTIVE:To analyze the factor affecting the results and the prognoses of radiotherapy for esophageal carcinoma with supraclavicular lymph node metastasis. METHODS: sixty-four primary esophageal carcinoma patients with supraclavicular lymph node metastasis were studied. The median follow-up time was 34 months (3-80 months). Thirty-three patients were found metastasis of supraclavicular lymph nodes after primary esophageal carcinoma had been treated, and 31 patients were found the metastasis when they were diagnosed. All patients were treated with the conventional radiotherapy. The total dose was 36-70 Gy/5-7 w, 1.8-2.0 Gy/d of the supraclavicular field. Forty-three patients were treated with radiotherapy alone, 16 patients were treated with radiotherapy followed by chemotherapy, and 5 ones were combined with thermotherapy. RESULTS: Of the 64 patients, complete regression (CR) was achieved in 23(39.5%); partial regression (PR) was achieved in 30(46.9%). The 1-, 3- and 5-year survival rates were 56.3%, 9.4%, 3.1%, respectively with the median survival time of 13.5 months. Thirty-seven patients (57.8%) died within the follow-up period, and 15 patients survived with disease-free, 7 ones survived with the neoplasm. Multivariate analysis showed that the diameter of supraclavicular metastasis lymph node (P=0.001), whether one side supraclavicular lymph node metastasis or both of two sides (P=0.015), and the number of supraclavicular lymph node metastasis (P=0.042) showed the statistical significant for the result of CR after radiotherapy, but only the diameter of supraclavicular metastasis lymph node was independent factor influencing the survival, P=0.010. CONCLUSIONS: The patients of esophageal carcinoma with supraclavicular lymph node metastasis can get some therapeutic efficacy with advanced radiotherapy, but combined therapy can not, improve the survival rate.