放疗照射方式差异对行同步放化疗颈胸上段食管癌患者预后及安全性的影响

目的:探讨放疗照射方式差异对行同步放化疗颈胸上段食管癌患者预后及安全性的影响。方法:回顾性分析我院2012年01月至2015年01月收治同步放化疗颈胸上段食管癌患者共66例临床资料，其中行选择性淋巴引流区照射（ENI）35例（A组），行累及野照射（IFI）31例（B组）；比较两组累积局部控制（LC）率、累积无进展生存（PFS）率、累积总生存（OS）率、失败模式及Ⅲ-Ⅳ级不良反应发生情况，采用Cox回归模型单因素和多因素分析预后影响因素。结果:A组随访累积LC率、累积PFS率及累积OS率均显著高于B组（P＜0.05）；A组总失败率和局部复发率均显著低于B组（P＜0.05）；两组远处转移率比较差异无统计学意义（P＞0.05）；两组Ⅲ-Ⅳ级不良反应发生率比较差异无统计学意义（P＞0.05）；单因素和Cox回归模型多因素分析结果显示，T分期、N分期及照射方式均是影响患者临床预后独立因素（P＜0.05）。结论:行同步放化疗颈胸上段食管癌患者采用ENI方案较IFI方案照射能够有效提高病情控制效果，延长生存时间，降低治疗失败率，且安全性良好。

Influence of radiotherapy methods difference on clinical prognosis and safety of patients with cervical and upper-thoracic esophageal cancer undergoing concurrent radiotherapy and chemotherapy

Objective:To investigate the influence of radiotherapy methods difference on clinical prognosis and safety of patients with cervical and upper-thoracic esophageal cancer undergoing concurrent radiotherapy and chemotherapy.Methods:Clinical data of 66 patients with cervical and upper-thoracic esophageal cancer undergoing concurrent radiotherapy and chemotherapy were retrospectively chosen in the period from January 2012 to January 2015 and divided into two groups including 35 cases with ENI radiation as A group and 31 cases with IFI radiation as B group.The cumulative local control rate(LC),cumulative progression free survival rate(PFS),cumulative total survival rate(OS),failure mode and adverse reactions with grade Ⅲ-Ⅳ occurrence of two groups were compared.Prognostic factors were analyzed by single factor and multi-factor analysis with Cox regression model.Results:The cumulative LC rate,PFS rate and OS rate of A group were significantly higher than B group（P＜0.05）.The total failure rate and local recurrence rate of A group were significantly lower than B group（P＜0.05）.There was no significant difference in distant metastasis rate between two groups（P＞0.05）.There was no significant difference in the incidence of adverse reactions for grade Ⅲ-Ⅳ between two groups（P＞0.05）.The results of univariate and Cox regression analysis showed that T stage,N stage and irradiation mode were all independent factors influencing the clinical prognosis of patients（P＜0.05）.Conclusion:Compared with IFI,ENI in the treatment of patients with cervical and upper-thoracic esophageal cancer undergoing concurrent radiotherapy and chemotherapy can effectively higher the disease control effect,prolong the survival time,reduce the treatment failure rate and possess satisfactory safety.