食管癌术后区域性复发的放疗

Radiotherapy for postoperative regional recurrence in esophageal carcinoma

目的 探讨食管癌根治术后不同部位复发放疗的疗效和预后影响因素。方法 回顾性分析 110例食管癌根治术后不同部位复发的病例 ,其中单纯颈部淋巴结转移 17例 ,纵隔淋巴结转移72例 ,腹部淋巴结转移 5例 ,吻合口复发 16例。放疗采用60 Co或 6MVX线 ,中位照射剂量为 6 2Gy。结果 全组放疗后 1、2、3、4年总生存率和中位生存期分别为 5 5 .4 %、30 .4 %、2 1.8%、14 .5 %和 14个月。单因素分析显示肿瘤复发部位、症状缓解情况、近期疗效、术后T分期及放疗总剂量与预后有关 ;多因素分析显示症状缓解情况和术后临床分期为独立预后因素。结论 食管癌术后复发放疗可以延长部分患者生存时间 ,手术时临床分期早以及放疗后症状缓解者预后较好。

Objective To study the significance of radical radiotherapy for r egional recurrence in esophageal carcinoma at different sites after radical surg ery and its prognostic factors. Methods 110 patients who developed regional rec urrence in esophageal carcinoma after radical resection were analyzed retrospect ively. The sites of recurrence were: supraclavicular lymph node 17, mediastinal lymph node 72, abdominal lymph node 5 and anastomotic stoma 16. Radiotherapy was given by 60Co unit or 6?MV X-ray with a median dose of 62? Gy (50-76?Gy). Results The overall 1-, 2-, 3-, and 4-year survival rates were 55.4%, 30.4%, 21.8 % and 14.5%, with a median of 14 months. Site of recurrence, T stage, total radi othe rapy dose, symptom amelioration level and total treatment response were related with prognosis, but only TNM stage and symptom amelioration level after radiothe rapy were independent prognostic factors. Conclusions Radiotherapy may improve t he survival in patients with postoperative recurrence in esophageal carcinoma. P atients with early lesion found at surgery and complete response of symptom afte r radiotherapy have better prognosis.