食管癌根治术后放疗与放化疗疗效比较

Clinical Analysis of Prophylactic Postoperative Radiotherapy or Sequence Radiotherapy and Chemotherapy in Esophageal Carcinoma

目的回顾性分析食管癌根治术后预防性放疗或放化疗的临床疗效.方法 163例食管癌根治术后2月内行预防性放射治疗,其中125例术后单纯放射治疗(单放疗组),38例行术后序贯性放疗和化疗(放化疗组).全纵隔放疗剂量45～60Gy,44例行双锁骨上预防性照射,剂量为50Gy.结果全组1、3、5年生存率和中位生存期分别为84.05%、 45.75%、35.89%和32个月.单因素分析显示肿瘤T分期、N分期、TNM病理分期、放疗总剂量和化疗与食管癌术后放疗的预后生存有关,P<0.05;多因素分析仅TNM分期和化疗是独立的预后因素.I+II期和III期的1、3、5年生存率和中位生存期分别为91.49%、55.81%、43.24%、45个月和73.91%、31.97%、26.23%、23个月(χ2=12.22,P=0.001).术后放化疗组1、3、5年生存率分别为84.21%、29.91%和24.93%,而术后单纯放疗组为84.00、50.60%和39.18%,P<0.05.结论 TNM分期和化疗是影响食管癌术后长期生存的独立预后因素,术后放化疗降低长期生存率的原因有待进一步探讨.

Objective To analysis clinical value of prophylactic radiotherapy or sequence radiotherapy and chemotherapy in esophageal carcinoma after surgery.Methods 163 esophageal carcinoma cases who had undergone radical resection followed prophylactic radiotherapy. Among them,125 cases treated with radiotherapy alone(RT group), 38 cases treated with sequence chemotherapy after radiotherapy(RCT group). Radiation treatment was started less than 2 months after operation. The fields encompassed the whole mediastinum in most patients, 44 cases inclosed bilateral supraclavicular areas. A mid plane dose of 45～60Gy in 23～30 fractions over 4.5 ～6 weeks was delivered.Results The overall 1, 3, 5 year survival rate and median survival time was 84.05% , 45.75% , 35.89% and 32 months respectively. Stage T, N, TNM, total doses of radiotherapy and chemotherapy effected prognosis of esophageal carcinoma treated with postoperative radiotherapy, P < 0.05 ; but only stage TNM and chemotherapy are independent prognostic factor. 1, 3, 5 year survival rate for stage III patients were 73.91% , 31.97% , 26.23% and was lower than 91.49% , 55.81% , 43.24% in stage I+II( χ 2 = 12.22 , P = 0.001 ). The 1, 3, 5 year survival rate was 84.00% , 50.6% and 39.18% for RT group and 84.21% , 29.91% and 24.93% for group RCT( χ 2 = 5.02 , P = 0.025 ). Conclusion TNM stage and chemotherapy are independent prognostic factor in patients of esophageal carcinoma accepted postoperative radiotherapy, the true reason why chemotherapy decreased survival in these patients need further research.