食管癌术后局部区域复发的治疗

目的　探讨食管癌术后局部区域复发的放射治疗方法。方法　食管癌术后局部区域复发 4 5例 ,其中锁骨上区复发 11例 ,纵隔复发 2 3例 ,锁骨上区加纵隔复发 5例 ,纵隔加吻合口复发 6例。全组均行放射治疗 ,剂量 5 0～ 80Gy ,19例疗后行FP方案化疗。结果　全组中位生存时间 12个月 ,1、2、3年生存率分别为 5 1.1%、2 6 .7和 11.1%。放射治疗后化疗与未行化疗者 ,3年生存率分别为2 1.1%和 3.9% ,但P >0 .0 5。多因素分析提示术后分期 (P =0 .0 2 3)及近期放射治疗效果 (P =0 .0 0 2 )与预后密切相关。结论　食管癌术后局部区域复发放射治疗是首选治疗方法 ,疗后局部控制好 ,预后也好 ,放射治疗剂量应以 6 0Gy以上为宜。

Treatment of loco-recurrence after resection of esophageal carcinoma

Objective To analyze the optimum method of radiotherapy for loco-regional recurrence in 45 patients after surgery for esophageal carcinoma. Methods From June 1993 to June 1999, 45 such patients were treated by radiotherapy. Eleven patients had recurrent lesions in the supraclavicular region, 23 in the mediastinum, 5 in both mediastinum plus supraclavicular area and 6 in mediastinum plus anastomotic orifice. A total dose of 50-80?Gy was given. Nineteen patients received FP (5-Fu+DDP) chemotherapy after radiotherapy. Results The medium survival was 12 months and the 1-, 2- and 3-year survival rates were 51.1%,26.7% and 11.1%. For those who received R+C and R only , the 3-year survival rates were 21.1% and 3.9%, showing a conspicuous raise in the survival although P>0.05. Multi-variate analysis showed that post-surgical staging (P=0.023) and radiotherapy (P=0.002) were closely related to prognosis.Conclusion Among the various methods of treating loco-regional recurrence after surgery of esophageal carcinoma , commonly yielding poor results, radiotherapy is still the method of choice. A total dose of >60?Gy is able to effect a good loco-regional control as well as a good result.