食管癌根治性放疗中ENI与IFI失败模式研究

目的 比较食管癌根治放疗中ENI与IFI后的失败模式,探讨局部区域复发转移的原因及影响因素。方法 回顾2006—2012年在本院接受根治性放疗的245例食管癌患者资料,其中接受ENI者126例,接受IFI者119例。分析疗后的失败模式,其中区域失败包括食管病变局部未控或复发及区域淋巴结复发或转移,远处转移包括远处脏器转移及区域外淋巴结转移。失败模式比较采用Kaplan-Meier法计算,并用Logrank法检验。结果 全组患者出现疗后失败163例,其中局部区域失败92例、单纯远处转移36例、区域失败伴远处转移35例。ENI与IFI疗后1、3、5年总失败率不相同,分别为35.4%、62.5%、69.0%与46.5%、71.5%、81.5%(P=0.036);1、3、5年局部区域失败率也不相同,分别为29.9%、48.4%、50.0%与39.6%、62.1%、71.4%(P=0.003)。结论 食管癌根治放疗时ENI可明显降低局部区域失败,提高LRC,进而改善长期生存。

A comparative study of failure patterns of definitive treatment of esophageal cancer with elective nodal irradiation and involved-field irradiation

Objective To compare the failure pattern between esophageal cancer patients receiving definitive elective nodal irradiation (ENI) and involved-field irradiation (IFI) and to investigate the reasons and influential factors for locoregional recurrence and metastasis. Methds A retrospective analysis was performed on the clinical data of 245 patients with esophageal cancer who received definitive radiotherapy in our hospital from January 2006 to December 2012. One hundred and twenty-six patients received ENI, and the other 119 patients received IFI. Failure patterns were analyzed after treatment. Locoregional failures included local esophageal lesion uncontrol or recurrence and regional lymph node recurrence or metastasis. Distant metastases included distant organ metastasis and distant lymph node metastasis. Comparison of failure pattern between the two therapies was made by chi-square test. Results One hundred and sixty-three patients had failure after treatment. Locoregional failure was observed in 92 patients, distant metastasis in 36 patients, and locoregional failure plus distant metastasis in 35 patients. The 1-, 3-, and 5-year overall failure rate for the ENI group were 35.4%, 62.5%, and 69.0%, respectively, versus 46.5%, 71.5%, and 81.5% for the IFI group (P=0.036). The 1-, 3-, and 5-year locoregional failure rates for the ENI group were 29.9%, 48.4%, and 50.0%, respectively, versus 39.6%, 62.1%, and 71.4% for the IFI group (P=0.003). Conclusions For esophageal cancer patients receiving definitive radiotherapy, ENI can significantly reduce locoregional failures and increase locoregional control, thus improving the long-term survival.