132例食管癌三维适形放疗的疗效分析

Efficacy of three-dimensional conformal radiotherapy for 132 patients with esophageal carcinoma

目的分析和评估三维适形放疗技术对食管癌患者的疗效及影响预后的因素。方法回顾分析3年间采用三维适形放疗的132例未手术食管癌患者的临床资料，分析其生存率、局部控制率和影响预后的因素。结果全组1、3、4年局部控制率分别为65．4．5％、52．9％、52．9％。全组1、3、4年生存率分别为50．7％、29．9％、25．7％，中位生存期为13个月。Ⅰ～Ⅲ期食管癌1、2、3、4年生存率分别为56．7％、36．7％、33．3％、30．3％，Ⅳ期1、2年生存率分别为35．2％、14．7％，没有3年生存，中位生存时间分别为15个月和9个月（X^2=8．17，P=0．004）。肿瘤长度≤8．0cm、分期均为Ⅰ-Ⅲ期、疗前没有穿孔征象、接受全程三维适形放疗的1、3、4年生存率分别为67．6％、46．3％、40．6％，中位生存时间为27个月。单因素分析显示疗前进食情况、穿孔征象、病变长度、TNM分期、疗后食管X线片评价是影响预后的因素。多因素分析显示穿孔征象、肿瘤长度是独立预后因素。结论三维适形放疗能明显提高部分食管癌患者的局部控制率和生存率。疗前是否有穿孔征象、肿瘤长度是影响预后的独立因素。

Objective To evaluate the efficacy of three-dimensional conformal radiation therapy （3DCRT） for esophageal carcinoma and identify prognostic factors in this patient group. Methods From May 2002 to Jun 2005,132 patients with unresectable or inoperable esophageal cancer were treated with 3DCRT in our hospital. Their clinical data were analyzed retrospectively. Results The 1- and 2-year local control rates was 65.4% and 52.1% in the whole group, respectively. The overall 1-and 2-year survival rate was 50.7% and 32.2% ,respectively. The median survival time was 13 months. The 1- and 2-year survival rate was 56.7%and 36.7% in stage Ⅰ ＋ Ⅲ ,respectively,with 35.2% and 14.7% in stage IV. The median survival time were 15 months and 9 months for stage Ⅰ ＋ Ⅲ and Ⅳ,respectively（X^2=8.17,P =0.004）. Of patients with stage Ⅰ＋ Ⅲ disease who were absent of perforation sign before radiotherapy, with lesion length less than 8.0 cm and whole course given by 3DCRT,the 1- and 2-year survival rate was 73.0% and 49.9%, respectively. Univariate analysis revealed that condition of alimentation, absence of perforation sign, short lesion length, early TNM stage were associated with good survival. Multivariate analysis confirmed that absence of perforation sign and lesion length were independent prognostic factors for survival. Conclusions 3DCRT is effective for esophageal carcinomas in terms of survival and local control. Further improvement could be achieved with multi-modality treatment. Absence of perforation sign and lesion length are independent prognostic factors for survival.