食管鳞癌累及野放疗的理论和实践

放化疗是非手术治疗食管癌患者的主要治疗手段,但关于食管癌放疗靶区范围,特别是淋巴结靶区仍未达成共识。食管癌具有高的淋巴结转移率,其转移模式难以预测。选择性淋巴引流区预防照射(ENI)会增加照射范围,这可能增加相关不良反应。部分研究报道累及野照射(IFI)减少治疗毒性并获得相似生存。研究显示化疗、放疗原发灶的附带照射以及放疗的远隔效应能对区域及远处微转移病变有效的控制和杀灭。从食管癌放疗后复发模式和生存上分析,无论采用ENI或IFI,最常见复发部位均为原发肿瘤部位及远处部位且生存无差异。研究提示食管癌放化疗采用IFI是可行的。

Theory and practice of involved-field radiotherapy for esophageal squamous cell carcinoma

Chemoradiotherapy is a major treatment for inoperable esophageal carcinoma (EC).However, there is still controversy over the target volume for radiation, particularly nodal target volume.EC is characterized by a high rate of lymph node metastasis, and its metastatic pattern is not always predictable.Elective nodal irradiation (ENI) will increase the radiation field, which may increase the incidence of adverse events.Some investigators used involved-field irradiation (IFI) to reduce treatment-related toxicities without compromising survival.Studies have demonstrated that regional and distant micrometastases can be controlled, to some extent, by chemotherapy, incidental irradiation, and the abscopal effects of radiation.With either ENI or IFI, EC recurrence is usually found in the primary tumor and at distant sites, without survival difference.These data suggest that IFI is feasible in EC patients.