根治性放疗后复发食管癌行手术和再放疗的回顾性研究

目的比较食管癌根治性放疗后复发患者行手术和再放疗的疗效。方法 57例食管癌根治性放疗后复发患者中手术治疗23例,再程放疗34例,分析手术的并发症、再放疗副作用及放射性损伤、无病生存率及总生存率。结果手术治疗组术后并发症:吻合口瘘1例,肺部感染3例;再放疗组:食管穿孔1例,食管气管瘘3例。手术组和再放疗组3年复发率分别为43.5%和82.4%,差异有显著性(P=0.033)。手术组和再放疗组1、2、3年总生存率分别为65.2%(15/23)、43.5%(10/23)、30.4%(7/23)和55.9%(19/34)、35.3%(12/34)、14.7%(5/34),无显著性差异(P=0.158)。手术组和再放疗组1、2、3年无病生存率分别为56.5%(13/23)、34.8%(8/23)、26.1%(6/23)和41.2%(14/34)、20.6%(7/34)、8.8%(3/34),差异有显著性(P=0.037)。结论食管癌根治性放疗后复发患者首选手术治疗,可以降低复发率,从而提高无病生存率。

Retrospective study the efficacy of the surgery or raditherapy again for recurrent patients with esophageal cancer after radical radiotherapy

Objective To compare the effects of surgery or radiotherapy again for recurrent patients after radical radiotherapy.Methods A total of 57 consecutive recurrent patients with esophageal squamous cell carcinoma underwent esophagectomy or radiotherapy again between January 2005 and January 2008 in First Hospital of Nanjing Medical University,Huaian,Jiangsu,P.R.China.23 patients underwent esophagectomy and 34 patients underwent radiotherapy again,posteroperative and radiotherapy complications,recurrenc rate and survival rate were compared retrospectively.Results Postoperative complications: anastomotic leakage in 1 patient and pulmonary infection in 3 patients;radiotherapy again complications: esophageal perforation in 1 patient and tracheoesophageal fistula in 3patients.Local recurrent rate was lower in surgery group than in radiotherapy group group(43.5% vs 82.4%,P=0.033).The 1-,2-,3-year overall survival rate was 65.2%、43.5%、30.4% in surgery group and 55.9%、35.3%、14.7% in radiotherapy group,P=0.158;the 1-,2-,3-year overall survival rate was 56.5%、34.8%、26.1% in surgery group and 41.2%、20.6%、8.87% in radiotherapy group,P=0.037.Conclusion Surgery is first choice for recurrent patients with esophageal squamous cell carcinoma after radical radiotherapy,can decrease local recurrence and increase disease-free survial rate.