食管癌三维适形放疗与常规放疗长期疗效和预后分析

目的:观察三维适形放射治疗（3DCRT）食管癌的长期疗效，并分析影响预后的因素。方法:回顾分析本院2003年-2007年间108例初治食管癌患者，其中三维适形放疗（3DCRT）组58例，常规放疗（CF）组50例，2.0Gy/次,5次/周,总剂量50-70Gy；观察近期疗效、局部控制率、生存率。Kaplan Meier 法计算局部控制率和生存率并Logrank法检验，Cox法多因素预后分析。结果:CF组和3DCRT组的有效率（CR＋PR）分别为88.0％、93.1％，两组比较差异有统计学意义（P＜0.05）。3DCRT组1、3、5、7年局部控制率分别为78％、61％、48％、39%,CF组分别为65.7%、36.6%、25.4%、21.4%,两组差异有统计学意义（P＜0.05）。3DCRT组和CF组的1、3、5、7年生存率分别为77．6％、46．6％、22．4％、12.1%和62.8％、31.5％、14.8％、9．8％，差异有统计学意义(P＜0.05)。单因素分析显示疗前进食情况、体重减轻≥10%、病变部位、病变长度、临床分期、近期疗效、照射剂量及是否采用三维适形放疗对生存期有影响。多因素预后分析显示临床分期、疗前进食情况、体重减轻≥10%、照射剂量为影响生存的因素。结论:3DCRT能明显改善食管癌近期缓解率、局部控制率和生存率,治疗前进食情况、临床分期、体重减轻≥10%和照射总剂量为其预后影响因素。

Long-term effect and prognosis of 58 patients with esophageal carcinoma treated by three dimensional conformal radiation therapy

Objective:To observe the results,side effects and prognosis of esophageal carcinoma treated with radiation therapy.Methods:All 108 patients were enrolled in the study,50 patients in conventional radiotherepy (CF)group and 58 patients in 3DCRT group.The patients received 2.0Gy/f,5 fractions a week to a total dose of 50-70Gy.Results:Effective rates（CR＋PR）were 88.0％and 93.1％ in CF group and in 3DCRT group respectively（P＜0.05）.The 1-,3-,5-and 7-year local control rates in CF group were 65.7%,36.6%,25.4% and 21.4%,while in group 3DCRT,it was 78％,61％,48％and 39% respectively.The 1-,3-,5-,7-year survival rates were 62.8％,31.5％,14.8％,9．8％in CF group and 77．6％,46．6％,22．4％,12.1% in 3DCRT group (P＜0.05).Logrank analysis showed dysphagia,weight loss ≥10% during treatment,clinical stage,irradiation dose,tumour length,tumor location,irradiation method were prognostic factors for the survival.Cox model multivariate analysis showed clinical stage,dysphagia,weight loss ≥10% during treatment and Lrradiation dose were prognostic factors for the survival.Conclusion:3DCRT can improve lately effection rate and the survival rate.Clinical stage，dysphagia,weight loss ≥10% during treatment and irradiation dose before treatment were prognostic factors for the survival.