局部复发食管癌挽救性放疗临床分析

Clinical Analysis of Salvage Radiotherapy for Local Recurrent Esophageal Carcinoma

目的分析挽救性放疗在局部复发食管癌治疗中的长期疗效和不良反应。方法对局部复发食管癌患者116例进行挽救性放疗。放疗技术为二维计划(15%)和三维适形计划(85%)。66例患者接受同步化疗。挽救性放疗或放化疗的中位剂量为45 Gy。结果中位随访时间38月(10~105月)。症状缓解率76%。中位总生存时间和无进展时间分别为14和8月。1、2、3年总生存率分别为56.9%、29.3%和14.7%。1、2、3年无进展生存率分别为43.1%、20.6%和10.4%。9例患者存活超5年(61~105月)。挽救性放疗剂量【45Gy组中位生存时间、3年生存率为9月和5%,而≥45 Gy组为19月和24%(P=0.001);传统二维照射技术组中位生存时间、3年生存率为4月和10%,而三维适形组为15月和19%(P=0.03)。急性不良反应主要是2~3度的放射性食管炎和放射性皮炎。无治疗相关死亡发生。结论挽救性放疗或放化疗对局部复发食管癌患者是有效的,特别是症状的缓解,且不良反应在可耐受的范围。局部复发食管癌的治疗效果总体不理想,然而挽救性放疗或放化疗后可以延长生存时间,甚至达到长期生存。即使患者初始治疗行过放疗,食管癌的挽救性放疗仍是有效的治疗方式。三维适形放疗和挽救性放疗大于45Gy的总剂量有更好的预后。

Objective To analyze the long-term efficacy and toxicity of salvage radiotherapy for local recurrent esophageal carcinoma. Methods One hundred and sixteen patients with local recurrent esophageal carcinoma underwent salvage radiotherapy. Radiotherapy technology was conventional twodimensional planning(15%) and conformal three-dimensional planning(85%). Sixty-six patients were treated with concurrent chemoradiotherapy. Salvage radio(chemo)therapy was carried out with a median dose of 45 Gy. Results Median follow-up time for surviving patients from the start of R(C)T was 38 months(range 10-105 months). Relief of symptoms was 76%. The median survival time was 14 months and the median recurrence-free interval was 8 months. The survival rates at 1, 2, and 3 years were 56.9%,29.3% and 14.7%, respectively. The recurrence-free survival rates at 1, 2, and 3 years were 43.1%, 20.6% and 10.4%, respectively. Nine patients lived more than 5 years(range 61-105 months). The median survival time and the survival rates at 3 years were 9 months and 5% in salvage radiotherapy dose<45 Gy group, while 19 months and 24% in those who received dose≥45 Gy(P=0.001). The median survival time and the survival rates at 3 years was 4 months and 10% in patients who used conventional two-dimensional planning, while 15 months and 19% in those who used conformal three-dimensional planning(P=0.03). Radiation esophagitis and radiodermatitis at grade 2 and 3 were most common acute toxicities. No treatment-related death was observed. Conclusion Salvage radio(chemo)therapy is effective for local recurrent esophageal carcinoma, especially for relief of symptoms. Toxicity is in an acceptable range. The outcome of local recurrent esophageal carcinoma is poor, however, longer survival after radio(chemo)therapy might be possible, even could reach long-term survival. A salvage radiation dose≥45Gy and conformal RT are associated with a better prognosis.