食管癌术后预防照射范围的临床研究

Portal size of prophylactic postoperative radiotherapy for esophageal carcinoma

目的比较和分析食管癌术后预防性放疗中照射野范围大小对生存率的影响。方法对102例食管癌根治术后放疗50～60Gy病例进行分析,大野组(43例)照射范围为双锁骨上区、全纵隔、吻合口及胃左区；小野组(59例)照射范围根据病变部位不同而不同：胸上段食管癌为食管瘤床、双侧锁骨上区、上中纵隔,胸中段食管癌患者为食管瘤床上下各扩大5cm及纵隔淋巴结引流区(不包括胃左区),胸下段食管癌包括瘤床、隆突下淋巴结区及胃左淋巴结区。结果全部病例1、3、5年生存率分别为76%、51%、43%,中位生存期为30个月。大野组1、3、5年生存率分别为77%、52%、41%,小野组的分别为76%、49%、45%(P=0．884)。多因素分析显示,N分期、淋巴结转移数目及病变长度是影响预后的独立因素。结论食管癌根治术后预防照射时,适当缩小照射野不会降低生存率。

Objective To compare and analyze the effect of prophylactic postoperative radiotherapy for esophageal carcinoma. Methods 102 such patients were treated with prophylactic radiotherapy after radical resection, to a total dose of 50-60 Gy. The extensive portal included supraclavicular region on both sides, entire mediastinum, the site of anastomosis and left gastric lymph node region in 43 patients. The regional portal range was different according to the different location of primary lesion in 59 patients. Results The 1-, 3- and 5-year survival rate was 76% , 51% and 43% respectively, with a median survival of 30 months. The 1-,3- and 5-year survival rate was 77%, 52% and 41% in the extensive portal and 76% , 49% and 45% in the regional portal, respectively（ P = 0.884）. According to multivariate analysis, N stage, number of metastatic lymph nodes and tumor length were independent prognostic factors. Conclusions Regional portal does not lower the survival rate when prophylactic postoperative radiotherapy is used in esophageal carcinoma.