食管鳞癌上纵隔1与2区淋巴结转移适形调强放疗回顾性分析

目的：探讨食管鳞癌根治术后上纵隔1与2区淋巴结转移患者放射治疗的疗效及预后影响因素。方法：回顾性分析2008—09—22—2012—04—19南京大学医学院附属鼓楼医院收治的36例食管鳞癌根治术后上纵隔1与2区淋巴结转移患者的临床资料，36例患者均接受了三维适形或调强适形放疗，联合化疗27例。生存分析和多因素分析分别采用Kaplan Meier法和Cox比例风险模型。结果：36例患者放疗结束后总有效率（CR＋PR）为77．8％（28／36），其中CR22．2％（8／36），PR55．6％（20／36），SD22．2％（8／36），PD0（0／36）；中位生存期为13个月，6个月、1和2年生存率分别为70．4％、52．5％和26．0％。单因素分析显示，术后分期（P=0．015）、转移淋巴结最大径（P=0．017）、放疗剂量（P=0．027）及放疗后是否达CR（P=0．026）对于食管鳞癌术后上纵隔1与2区转移淋巴结放疗疗效有显著影响。Cox多因素分析表明，术后分期（P=0．006）和放疗剂量（P=0．010）为独立的预后影响因子。结论：食管鳞癌根治术后发生上纵隔1与2区淋巴结转移者，可采用三维适形或调强适形放疗作为补救治疗方案，术后临床分期较早或高剂量放疗组放射治疗后的预后分别优于术后分期晚及低剂量放疗组。

Conformal or intensity modulated radiotherapy for esophageal squamous cell carcinoma patients with upper mediastinal group 1,2 lymph nodes metastases

OBJECTIVE： To evaluate the efficacy of radiotherapy on upper mediastinal group 1,2 lymph nodes metastases from esophageal squamous cell carcinoma after radical surgery, and investigate prognostic factors. METHODS： The clinical data of 36 eases of upper mediastinal group 1,2 lymph nodes metastases from esophageal squamous cell carcinoma after radical surgery were analyzed retrospectively. All the 36 patients were treated with three dimensional conformal or intensity modulated radiotherapy. Twenty-seven patients received chemoradiotherapy. Survival and multivariate analysis were performed by methods of Kaplan-Meier and Cox regression proportional hazard model respectively. RESULTS： For all the 36 patients, the whole response rate（CRq-PR） was 77. 8% （28/36） including CR 22. 2% （8/36）, PR 55. 6% （20/36）, SD 22.2 % （8/36） and PD 0 （0/36） respectively. The median survival time was 13 months, while 6 months, 1 and 2 year survival rates were 70.40%,52.5 % and 26.0% respectively. Univariate analysis indicated that postoperative stage, the largest diameter of lymph node metastasis,irradiation dose and locoregional response significantly affected the prognosis （P = 0.015, P = 0.017, P = 0. 027, P = 0. 026）. Cox multivariate analysis showed that the independent prognostic fac- tors were postoperative stage and irradiation dose（P = 0. 006, P= 0. 010）. CONCLUSIONS： Three dimensional conformal or intensity modulated radiotherapy can be an effective salvage therapy for patients with upper mediastinal group 1,2 lymph nodes metastases from esophageal squamous cell carcinoma after radical surgery. The cases with early postoperative stage or receiving high irradiation dose after radiotherapy have statistically better prognosis.