Ivor—Lewis手术辅助放疗对ⅡA期中段食管癌局部控制的临床研究

The local control of radiotherapy following Ivor-Lewis esophagectomy in the patients with stage Ⅱ A middle-third thoracic esophageal cancer

目的探讨Ivor-Lewis手术后辅助放疗对ⅡA期胸中段食管鳞状细胞癌的局部控制作用。方法回顾性分析1999年6月至2002年6月间接受Ivor—Lewis手术治疗的125例ⅡA期胸中段食管鳞状细胞癌患者的临床资料。Kaplan—meier法计算生存率，x^2检验比较不同辅助治疗方案的肿瘤局部复发率差别。结果本组患者3年和5年生存率分别为58．4％和43．2％。3年内61例（48．8％）肿瘤复发，其中局部．区域性复发38例（30．4％）。手术后辅助放疗组局部复发率20．3％，低于手术后辅助化疗组的40．6％和未经辅助治疗组的41．4％（P〈0．05）。结论Ivor—Lewis手术辅助术后放疗，是对ⅡA期胸中段食管鳞状细胞癌实现局部控制的有效方法。

Objective To investigate the local control of radiotherapy following Ivor-Lewis esophagectomy in the patients with stage Ⅱ A middle-third thoracic esophageal cancer. Methods From June 1999 to June 2002, 125 patients with stage Ⅱ A squamous cell carcinoma of the middle-third thoracic esophagus were treated with Ivor-Lewis esophagectomy with two-fields lymphadenectomy. The survival rate was calculated by Kaplan-meier method and the difference of recurrence rate compared by X^2 test. Results The 3-year and 5-year survival rates were 58.4% and 43.2% in this group, respectively. Tumor recurrence occurred in 61 of the 125 patients （48.8%） within 3 years after operation. Of all cases of recurrence, 38 patients （30. 4% ） developed locoregional recurrence （including 5 patients with locoregional and hematogenous recurrence simultaneously ）. The locoregional recurrence rate of patients who received postoperative radiotherapy （20. 3% ） was significantly lower than that of both the group who received adjunctive chemotherapy （ 40. 6% ） and the group without adjunctive therapy （ 41.4% ） （ P 〈 0.05 ）. Conclusions About half of the patients would develop recurrence disease within 3 years after Ivor-Lewis esophagectomy with two-fields lymph-adenectomy. Radiotherapy following Ivor-Lewis esophagectomy is an effective strategy to control local recurrence of the stage Ⅱ A middle-third thoracic esophageal cancer.