胸段食管癌术后预防照射靶区的最优尺度分析

目的探讨胸段食管癌术后复发、转移的临床特征，了解术后放疗的靶区。方法回顾性分析144例食管癌术后复发转移部位，应用最优尺度分析描述其分布与原发肿瘤部位关系。结果144例术后复发转移病例肿瘤中位进展时间18．43个月（15．68-21．18个月）。共发生复发转移362个部位，其中吻合口复发、远处转移、颈部／锁骨上淋巴结、I～II区、川区、IV区、V区、VI区、VII区、VIII区、X～XI区、腹部淋巴结转移分别是19例（13．2％）、48例（33.3％）、52例（36．1％）、40例（27．8％）、34例（23．6％）、45例（31_3％）、35例（24．3％）、2例（1．4％）、45例（31．3％）、13例（9．0％）、1例（0．7％）、28例（19．4％）。原发灶在胸上段的与颈部-／锁骨上转移，吻合口无复发有联系；原发灶在胸中段的与无远处转移、腹部淋巴结无转移、…区、VII区转移有联系；原发灶在胸下段的与远处转移、腹部淋巴结转移，颈部／锁骨上淋巴结、I～II区、III区、IV区、V区、VII区无转移有联系。其他淋巴结区情况尚无法明确。结论不支持胸段食管癌术后包括颈部／锁骨上、纵隔及腹部淋巴结等部位的大野照射；不同原发灶部位建议区别对待，胸上段食管癌颈部／锁骨上区为必需照射靶区，吻合口可不作为靶区；胸中段食管癌3区、7区为必需照射靶区，腹部淋巴结可不作为靶区，可不加用化疗。胸下段食管癌颈部／锁骨上、I～II区、II区、IV区、V区、VII区可不作为靶区，腹部淋巴结必需作为靶区，因胸下段食管癌因与远处转移有联系，建议加用化疗。胸上段食管癌病例数较少，结果不一定可信。

Cfinical Study on the Target of Prophylactic Radiotherapy in Postoperative Thoracic Esophageal Carcinoma

Objective To analyze clinical characteristics of recurrence and metastasis in postoperative thoracic esophageal carcinoma, study the target of prophylactic radiotherapy.Methods retrospective analysis of recurrence and metastasis in 144 patients were done using optimal scaling.Results The median time to progress was18.43 months （15.68-21.18 months） .144 patients had 362 recurrences and metastases.anastomotic stoma recurrences,hematogenous metastases,cervical lymph node,region I - II ,region III ,region IV,region V ,region V/,regionVlI,region,region X -XI ,abdominal lymph node metastases were observed in 19（13.2%）,48（33.3%）,52（36.1%）,40（27.8%）,34（23.6%）,45（31.3%）,35（24.3%）,2（1.4%）,45（31.3%）,13（9.0%）,1（0.7%）,28 patients （19.4%）,respectively.The upper esophagus have relationship with metastases of cervical nodes,non- recurrences of anastomotic stoma;The middle esophagus have relationship with hematogenous non-metastases,non-metastases of abdominal lymph node,metastases of region III,region Vl/;The lower esophagus have relationship with hematogenous metastases,metastases of abdominal lymph node,and non-metastases of cervical lymph node,region I - II ,region I~,regionIV,region V ,regionVII.Conclusion The result did not support that the irradiation field in postoperative thoracic esophageal carcinoma have to include cervia,mediastinum and abdominal lymph node.The irradiation field of different region must be discriminated.In the upper thoracic esop.hageal carcinoma,cervical lymph node need to be included in the irradiation field,anastomotic stoma was not required as the targets; In the middle thoracic esophageal carcinoma,the region III and VII need to be included in the irradiation field ,abdominal lymph node was not required as the targets.chemotherapy is not applied sufficiently.In the lower thoracic esophageal carcinoma,abdominal lymph node need to be included in the irradiation field ,region I - II ,III, IV, V ,VII are not required as the targets.The lower-thoracic carcinoma correlates with hematogenous metastase,so it is suggested that they are applicated chemotherapy.The cases of upper, thoracic esophagus are few, and the results are not entirely credible.