食管腔内超声检查预测食管癌放射敏感性的临床研究

Endiscopic ultrasonography in prediction of radiosensitivity of esophageal carcinoma

目的探讨食管腔内超声检查食管癌放疗中肿瘤消退程度能否作为临床预后疗效观测指标，为临床判断不同放射敏感性提供依据。方法接受首程放疗的51例食管癌患者入组，其中单纯放疗35例，同步放化疗10例，术前放疗或化疗6例。放疗前和放疗38～40Gy时行食管腔内超声检查，同时测量肿瘤最大直径，并根据其变化程度分为缓解组（直径缩小〉150％）和稳定组（直径缩小〈50％）。结果随访率为100％。全组中位生存期为24．3个月，2年生存率为47％。缓解组和稳定组2年生存率分别为69％和37％（x^2=5．78，P=0．016），2年无进展生存率分别为59％和29％（x^2=3．97，P=0．046）。35例单纯放疔的缓解组（11例）和稳定组（24例）2年生存率分别为60％和20％（x^2=5．84，P：0．016），2年无进展生存率分别为44％和10％（x^2=4．20，P=0．040）。术前放疗或化疗6例中5例为缓解组，其中4例有重度放疗反应，1例有中度放疗反应；1例为稳定组，仅有轻度放疗反应。结论食管腔内超声检查在食管癌放疗前和放疗中检测肿瘤消退程度是临床有效观测指标之一，对预后判断有明显指导作用。

Objective To study if tumor retraction assessed by endiscopic uhrasonography （EUS） during radiotherapy has prognostic value in esophageal carcinoma, which may further predict the radiosensitivity. Methods The maximal tumor thickness was measured by EUS before radiotherapy and at 40 Gy in patients with esophaged carcinoma. Response was defined as at least 50% reduction in tumor thickness. Resuits A total of 51 patients were included. The median follow-up time was 28.5 months. The median survival time was 24.3 months. The treatment was radiotherapy alone, concurrent ehemoradiotherapy and preoperative treatment in 35, 10 and 6 patients, respectively. Tumor response was assessed by EUS in 18 patients （34%）. The 2-year overall survival （OS） and progression-free survival （PFS） were 69% and 59% for responders, comparing with 37% and 29% for non-responders （ X^2 = 5.78, P = 0. 016 and X^2 = 3.97, P =0. 046, respectively）. In radiotherapy alone group, the 2-year OS and PFS were significantly higher in responders （ n = 11 ） comparing with non-responders （ n = 24 ） （ 60% vs 44%, X2 = 5.84, P = 0. 016 and 20% vs 10% ,X^2 =4.20, P =0. 040）. In preoperative radio （chemo） therapy group （n =6）, pathologically complete response, partial response and minimal response were observed in 4, 1 and 1 patients, respectively. EUS detected tumor response in 4 of 5 （ 80% ） patients with tumor regression, and non-response in 1 of 1 patient without tumor regression. Conclusions The prognosis is better in patients with esophageal carcinoma responding to neoadjuvant treatment identified by EUS than that of non-responders.