112例进展期食管癌根治术后放射治疗的疗效分析

Clinical analysis of prophylactic radiotherapy after curative resection for 112 patients with esophageal carcinoma

目的:探讨进展期食管癌根治术后单纯放疗和放化联合治疗的临床意义。方法:回顾性分析112例进展期食管癌根治性切除术后进行放射治疗的患者,其中34例单纯放疗,49例序贯放化疗(化疗用PF或CMF方案2～4周期),29例同步放化疗(化疗用优福定口服,每次4片(0.648g),每日3次,连续2～4周)。放疗全纵隔野采用15MV-X线,DT50～60Gy/25～30次;锁骨上野为6MV-X线,Dm50Gy/22～23次。结果:全组1、3、5年总生存率分别为77.7%、45.5%、25.9%。术后单纯放疗组、术后序贯放化疗组与术后同步化疗组在放疗毒副反应和1、3、5年无复发生存率(P=0.423)及总生存率(P=0.138)等方面差异无显著性。而Ⅲ、Ⅳ期患者在5年总生存率三组间有显著性差异(P=0.028)。结论:术后序贯放化疗较单纯放疗在局控和长期生存方面无明显获益,而联合优福定的术后同步放化疗安全可行,Ⅲ、Ⅳ期患者可能获益更大。

Objective：To evaluate the clinical value of prophylactic radiotherapy alone （RT alone） and sequential （S-RCT） or concurrent （C-RCT） radiotherapy and chemotherapy in esophageal carcinoma after surgery. Methods： One hundred and twelve esophageal carcinoma cases who received postoperative prophylactic radiotherapy was analysised retrospectively, among which 34 cases, 49 cases and 29 cases were treated with RT alone, S-RCT and C-RCT respectively. Tegafur was precribled while radiotherapy in C- RCT group. The radiation portals encompass the whole mediastinum and bilateral supraclavicular areas. A mid-plane dose of 50-60Gy in 25-30 fractions over 5-6 weeks was delivered. Results：The overall 1 ,3,5-year survival rate was 77.7% , 45.5% , and 25.9% , respectively. In RT alone group, it was 67.7% , 35.3% and 20. 6% , and those of S-RCT group was 79.6% , 44. 9% and 20. 4% , and those of C-RCT group was 86. 2% , 58.6% and 41.4%. No significant difference was got among the three groups with overall survival rate, recurrence-free survival rate or complication of therapy. But for stage Ⅲ and Ⅳ patients, the 5-year survival rate was markerly higher in the C-RCT group than in the group of RT alone （P = 0. 028 ）. Condusion：Compared with radiotherapy alone, sequential radiotherapy and chemotherapy is not able to improve the survival rate or reduce the incidence of failure of esophageal carcinoma after surgery, while concurrent chemoradiotherapy using tegafur is safety and could increase the 5-year survival rate in stage Ⅲ and Ⅳ cases.