食管癌根治术后放疗与放化疗疗效比较

 目的 回顾性分析食管癌根治术后预防性放疗或放化疗的临床疗效。方法 163例食管癌根治术后2月内行预防性放射治疗，其中125例术后单纯放射治疗(单放疗组)，38例行术后序贯性放疗和化疗(放化疗组)。全纵隔放疗剂量45～60Gy，44例行双锁骨上预防性照射，剂量为50Gy。结果 全组1、3、5年生存率和中位生存期分别为84．05％、45．75％、35．89％和32个月。单因素分析显示肿瘤T分期、N分期、TNM病理分期、放疗总剂量和化疗与食管癌术后放疗的预后生存有关，P

Clinical Analysis of Prophylactic Postoperative Radiotherapy or Sequence Radiotherapy and Chemotherapy in Esophageal Carcinoma

Objective 　To analysis clinical value of prophylactic radiotherapy or sequence radiotherapy and chemotherapy in esophageal carcinoma af ter surgery. Methods 　163 esophageal carcinoma cases who had undergone radical resection followed prophylactic radiotherapy. Among them ,125 cases t reated with radiotherapy alone ( RT group ) , 38 cases t reated with sequence chemotherapy af ter radiotherapy ( RCT group) . Radiation t reatment was started less than 2 months af ter operation. The fields encompassed the whole mediastinum in most patient s , 44 cases inclosed bilateral supraclavicular areas. A mid-plane dose of 45～60 Gy in 23～30 f ractions over 4. 5～6 weeks was delivered. Results 　The overall 1 , 3 , 5-year survival rate and median survival time was 84. 05 % , 45. 75 % ,35. 89 % and 32 months respectively. Stage T , N , TNM , total doses of radiotherapy and chemotherapy effected prognosis of esophageal carcinoma treated with postoperative radiotherapy , P < 0. 05 ; but only stage TNM and chemotherapy are independent prognostic factor. 1 , 3 , 5 year survival rate for stage III patient s were 73. 91 % ,31. 97 % ,26. 23 % and was lower than 91. 49 % ,55. 81 % ,43. 24 % in stage I + II(χ2 = 12. 22 , P = 0. 001) . The 1 , 3 , 5 year survival rate was 84. 00 % , 50. 6 % and 39. 18 % for RT group and 84. 21 % ,29. 91 % and 24. 93 % for group RCT(χ2 = 5. 02 , P = 0. 025) . Conclusion 　TNM stage and chemotherapy are independent prognostic factor in patient s of esophageal carcinoma accepted postoperative radiotherapy , the t rue reason why chemotherapy decreased survival in these patient s need further research.