食管癌治疗后纵隔淋巴结转移三维适形放疗的初步研究

Three-dimensional Conformal Radiotherapy for Mediastinal Lymph Node Metastasis after Treatment of Esophageal Carcinoma

目的探讨食管癌治疗后纵隔淋巴结转移灶三维适形放射治疗的意义和效果。方法回顾性分析46例食管癌治疗后发生纵隔淋巴结转移的患者。其中术后转移的有25例，纵隔淋巴结转移复发平均时间为19．2月；放疗后转移的有21例，复发平均时间为14．3月。食管癌术后的病例先采用常规放疗，DT：40～44Gy／20～22次．然后采用适形放疗，总剂量达60～68Gy。放疗后的病例均采用适形放疗，CTV为2—2．5Gy／次，5次／周，每次3～5个照射野投照，总剂量60～68Gy。结果治疗后3个月复查，术后病灶的有效率达88．0％，放疗后的有效率达71．4％，比效结果有显著性差异（P〈0．05）。放射性肺部症状，术后和放疗后分别为68．0％和71．4％，比效结果无差异（P〉0．05）。放射性食管症状。术后和放疗后分别为24．0％和66．6％，比效结果有显著性差异（P〈0．05）。结论食管癌治疗后发生纵隔淋巴结转移进行三维适形放射治疗可以明显提高局部控制率，且副作用小。

Objective To value 3-dimensional conformal radiotherapy （3-DCRT） for mediastinal lymph node metastasis after treatment of esophageal carcinoma. Methods Retrospective analysis of 46 such patients treated by 3-DCRT was conducted. Lymph node diameter was ; 〈 2 cm in 5 patients, 2 -3 cm 25 patients and 〉 3 cm 15 patients. For postoprative 25 patients, the average time of relapse was 19.2 months and postradiotherapy 21 patients, 14.3 months. Patients after surgery accepted conventional radiotherapy at the dose of, DT 40Gy-44 Gy/20 fx-22fx, then received 3-DCRT, the dose was boost to 60-68 Gy. Patients after radiotherapy were all treated by 3-DCRT, dose was 60 68 Gy, 2-2.5 Gy/fx, 5fx/w, 3-5field/fx. Results Complete response rate of Postoprative patients and Postradiotherapy patients was 88.0% and 71.4 % respectively. Three month later the treatment was concluded and the result is statistical significant （P 〈 0.05）. Radioactive lung symptoms occurred at a rate of 68.0 % and 71.4 % in the two ases respectively, not statistically significant （P〉0.05）. Radioactive esophagus symptoms occurred at a rate of 24.0% and 66.6% respectively, statistically significant （P〈 0.05）. Conclusion Three-dimmensional conformal radiotherapy, with little side-effects, can markedly improve the local control rate and suvival rate Of patients with mediastinal lymph node metastasis after treatment of esophageal carcinoma.