食管癌放射治疗肿瘤退缩速度对局部控制的影响

目的：探讨食管癌患者根治性放射治疗过程中肿瘤退缩速度对局部控制的影响意义。方法：1997年3月～2001年3月期间392例初治的食管癌患者在我院接受后程加速超分割照射，处方剂量65～70Gy。放射治疗过程中第5周（处方剂量45-50Gy）以及治疗结束（处方剂量65～70Gy）时全面评估肿瘤的退缩情况，在50Gy之前完全退缩的定义为快速退缩，50-70Gy之间完全退缩定义为缓慢退缩，其余定义为残留。结果：77例（20％）快速退缩，151例（38．5％）缓慢退缩，164例（41．5％）有残留。快速退缩组、缓慢退缩组、残留组3年局部区域控制率为64．9％、68．8％、46．3％。肿瘤退缩速度显著影响食管癌患者的3年无局部区域失败生存率。分层分析发现肿瘤退缩速度、CT-T分期影响局部控制。结论：根治性放疗过程中肿瘤退缩速度影响食管癌患者的局部区域控制率，肿瘤残留提示局部区域控制不良。

Influence of Tumor Regression Rate on Locoreglonal Control of Esophageal Carcinoma

Objective:To evaluate the effect of tumor regression rate during radiation therapy on locoregional control of esophageal carcinoma.Methods: Between March 1997 and March 2001,392 previously untreated patients with esophageal carcinoma received radical late course accelerated hyperfractionation radiotherapy(LCAHR).The prescribed external radiation dose was 65~70 Gy to the primary disease.The size of primary lesions were evaluated by endoscopy on a weekly interval during the entire course of radiotherapy,fast regression was defined as a complete response before dose 50 Gy,slow regression with dose in the range of 50~70 Gy,other cases as residual disease.Results: The fast response group consisted of 77 patients(20%),the slow response group 151 patients(38.5%),and the residual group 164 patients(41.5%).Local regional failure-free rates were affected by the tumor regression rate.(P<0.05).The 3-year local regional failure-free rates in the fast,slow regression and residual groups were 64.9%,68.8% and 46.3%,respectively.Multivariate analysis found that tumor regression rate,CT-T stage were the prognostic factors for loco-regional control.Conclusion: Tumor regression rates during radiation therapy have a prognostic influence on locoregional control for esophageal carcinoma,residual disease at the end of radical radiotherapy indicates a poor local-regional control.