吞钡X线检查观察食管癌放射治疗过程中肿瘤退缩的临床价值

Clinical Value of Barium Swallow in Observing Esophageal Tumor Regression during Radiotherapy

背景与目的:食管吞钡X线检查由于简便、经济,国内广泛作为食管癌疗效观察和长期随访的常规检查项目,本研究通过食管癌患者放疗中食管吞钡X线观察肿瘤退缩速度,并分析肿瘤退缩速度与近期疗效、远期生存的关系,探讨该检查在食管癌放射治疗中的临床价值。方法:总结2001年1月至2003年6月我院确诊并在我科行放射治疗,病理为鳞状细胞癌的食管癌94例,临床分期Ⅱ期(18例,19.1%)、Ⅲ期(36例,36.3%)、Ⅳ期(42例,44.6%),KPS≥70,CT模拟机定位放射治疗,其中单纯放疗39例,同期放化疗55例。观察放疗40Gy及放疗结束食管吞钡X线影像,按1981年全国放射学术会议(郑州会议)标准分级,并根据放疗中分级变化判断肿瘤消退速度:A组,放疗中肿瘤快速退缩,放疗40Gy食管吞钡X线改变为Ⅰ、Ⅱ级;B组,放疗中肿瘤缓慢退缩,放疗40Gy食管吞钡X线改变为Ⅲ、Ⅳ级,放疗结束食管吞钡X线改变达到Ⅰ、Ⅱ级;C组,放疗结束肿瘤明显残留,放疗结束食管吞钡X线仍为Ⅲ、Ⅳ级。结合临床综合分析与近期疗效和远期生存率的关系。结果:A、B、C组近期疗效达到CR比例分别为100.0%、65.2%、28.3%,P<0.001;3年总生存率分别为44.0%、24.2%、17.3%,多因素分析,近期疗效(P<0.001)、M分期(P=0.029)是影响预后的独立因素;B、C组中近期疗效达到CR患者3年生存率(32.6%、42.2%)与A组(44.0%)相似,P=0.814。A组死于局部未控或复发比例较低(A组50%,B组88%,C组81%),死于放疗后严重并发症比例相对较高(A组19%,B组0%,C组6%)。结论:观察食管吞钡X线改变可以判断食管放疗过程中肿瘤消退的速度和程度。消退速度与近期疗效密切相关。近期疗效是影响预后的重要因素。

BACKGROUND ＆ OBJECTIVE： Barium swallow is widely used to observe the treatment response of esophageal squamous cell carcinoma （ESCC） and as a routine examination for long-term follow-up in China because of its convenience and inexpensiveness. This study was to observe esophageal tumor regression by barium swallow during radiotherapy, analyze the correlations of tumor regression speed to short-term response and longterm survival, and evaluate the clinical value of barium swallow during radiotherapy for ESCC. METHODS： Clinical data from 94 patients with ESCC, treated with radiotherapy （39 patients） or chemoradiotherapy （55 patients） from Jan. 2001 to Jun. 2003 at Cancer Center of Sun Yat-sen University, were retrospectively reviewed. Of the 94 patients, 18 （19.1%） were at stage Ⅱ , 36 （36.3%） at stage Ⅲ , and 42 （44.6%） at stage Ⅳ. Barium swallow was performed at the radiation dose of 40 Gy and the radiation end, and the X-ray appearance was classified according to Zhengzhou Meeting criteria. The patients were divided into 3 groups according to their tumor regression speed： Group A had rapid regression, with the X-ray appearance classified as grade Ⅰ or Ⅱ at 40 Gy; Group B had slow regression, with the X-ray appearance classified as grade Ⅲ or Ⅳ at 40 Gy, but as grade Ⅰ or Ⅱ at the radiation end; Group C had obvious residual tumors, with the X-ray appearance kept being classified as grade Ⅱ or Ⅳ till radiation end. The correlations of tumor regression speed to short-term response and long-term survival were analyzed. RESULTS： The complete response （CR） rates were 100.0% in Group A, 65.2% in Group B, and 28.3% in Group C （P〈0.001）; the 3-year survival rates were 44.0%, 24.2%, and 17.3%, respectively （P〈 0.001 ）. Multivariate Cox regression analysis showed that short-term response and M stage were independent prognostic factors. The 3-year survival rates of CR patients were 44.0% in Group A, 32.6% in Group B, and 42.2% in Group C （P=0.814）. The Iocoregional failure rates were 50% in Group A, 88% in Group B, and 81% in Group C, and the occurrence rates of severe radiation-related complications were 19%, 0%, and 6%, respectively. CONCLUSIONS： Barium swallow during radiotherapy for ESCC could be used to judge tumor regression speed, which is closely related to short-term response. Short-term response is an important prognostic factor of ESCC.