Ⅱ和Ⅲ期胸段食管癌术后预防性三维放疗疗效分析

目的 分析三维适形放疗(3DCRT)或调强放疗(IMRT)技术对Ⅱ、Ⅲ期胸段食管癌根治术后预防性放疗的疗效及不良反应。方法 2004—2009年间本院行食管鳞状细胞癌根治术患者 251例,术后病理分期为Ⅱ期 95例、Ⅲ期 156例。3DCRT的 20例,IMRT的 231例,中位剂量60 Gy。采用Kaplan-Meier法计算生存率并Logrank法检验和单因素预后分析,Cox回归模型多因素预后分析。结果 随访率为98.8%,随访满3、5年者分别为159、57例。全组1、3、5年生存率分别为90.8%、56.1%、45.8%。Ⅱ_a、Ⅱ_b、Ⅲ期的 5年生存率分别65.0%、53.8%、38.4%(χ²=7.30,P=0.026)。淋巴结阴性与阳性的 5年生存率分别64.9%、40.4%(χ²=7.04,P=0.008)。单因素分析显示病理分期、淋巴结是否转移、肿瘤分化程度、脉管瘤栓为影响预后因素(χ²=7.30、7.04、8.34、9.40,P=0.026、0.008、0.004、0.002),多因素分析显示肿瘤分化程度、淋巴是否结转移、脉管瘤栓为影响预后因素(χ²=6.86、5.27、4.24,P=0.009、0.022、0.040)。主要失败原因中血道转移 58例、锁骨上淋巴结转移 14例、腹腔淋巴结转移 17例、胸腔内复发 31例。主要晚期不良反应中≥2级吻合口狭窄 5例、大出血 8例。结论 3DCRT或IMTR技术对食管癌根治术后预防性放疗明显降低放疗部位复发率和提高生存率且不良反应低。Ⅲ期和有淋巴结转移食管癌术后患者应预防性放疗。

A efficacy analysis of intensity-modulated radiotherapy or three-dimensional conformal radiotherapy for resected thoracic esophageal squamous cell carcinoma

Objective To analyze retrospectively the clinical therapeutic effect and toxicities of three-dimensional conformal radiotherapy (3DCRT) or intensity-modulated radiotherapy (IMRT) for resected stage Ⅱ/Ⅲ thoracic esophageal squamous cell carcinoma (TESCC). Methods A total of 251 patients with resected TESCC underwent 3DCRT or IMRT at the Cancer Hospital (Institute), Chinese Academy of Medical Sciences between 2004.1 to 2009.7 enrolled. Postoperative radiotherapy applied via 3DCRT (20 patients) or IMRT (231 patients) with a median total dose of 60 Gy. The Kaplan-Meier method was used to calculate the survival rates, and the log-rank test was used for univariate analysis. The Cox proportional model was used for multivariate analysis. Results The follow-up rate was 98.8%. 159 and 57 patients were followed to 3 and 5 years, respectively. The 1-, 3-and 5-year overall survival (OS) rates for all the patients were 90.8%, 56.1% and 45.8%, respectively. For the stage Ⅱ_a, Ⅱ_b, and Ⅲ stage patients, the 5-year OS rates were 65.0%, 53.8% and 38.4%, respectively (χ²=7.30,P=0.026). The 5-year OS rates were 64.9% and 40.4% for the patients with negative and positive lymph node metastasis (χ²=7.04,P=0.008). Univariate analysis showed that the significant prognostic factors include UICC 2002 stage, the degree of differentiation, lymphatic metastasis and vascular carcinomatous thrombus (χ²=7.30,7.04,8.34,9.40,P=0.026,0.008,0.004,0.002). Multivariate analysis revealed that the grade of differentiation, lymphatic metastasis and vascular carcinomatous thrombus were independent prognostic factors (χ²=6.86,5.27,4.24,P=0.009,0.022,0.040). Treatment failure occurred in 58patients because of systemic metastases, 14 cervical lymph node recurrence, 17 abdominal lymph node metastases, and 31 of intrathoracic recurrence. Five patients had grade 2 or worse late treatment-related anastomotic stenosis, and 8 patients died from late treatment-related gastrointestinal bleeding. Conclusions
Postoperative prophylactic 3DCRT or IMRT of TESCC can provide a favorable local control rate and acceptable toxicity. Postoperative radiotherapy should be included into the standard treatment of Stage Ⅲ TESCC or TESCC with lymph node metastasis.