食管癌术前大剂量短程放疗的临床研究

Large Dose and Short Course Preoperative Radiotherapy and Surgical Treatment in the Esophageal Cancer

１９９３年２月至１９９４年１２月对８７例食管癌患者进行大剂量短程术前放疗，８６例做了食管癌切除颈部Ｇａｍｂｅｅ＇ｓ吻合术，１例单纯探查（Ⅰ组）。同期食管癌患者９９例，行单纯手术治疗（Ⅱ组），作为对照组。放疗方法：２０～２５ＧＹ／４～５次／４～５天，放疗后１～７天行手术治疗。结果：全部患者均可耐受大剂量放疗。术中见肿瘤变软、缩小；手术出血量、手术时间、术后并发症与对照组相比无明显差异。手术切除率：Ⅰ组９９％（８６／８７），Ⅱ组８９％（８８／９９），Ｐ＜０．０５。手术死亡率：Ⅰ组０，Ⅱ组２％（２／９９）。术后生存率：１年Ⅰ组６８．６％（５９／８６），Ⅱ组６４．８％（５７／８８）；２年Ⅰ组５０．０％（４３／８６），Ⅱ组４６．６％（４１／８８）；３年Ⅰ组４６．９％（１５／３２），Ⅱ组３７．５％（１２／３２）。

87 cases of esophageal cancer were adopted large dose and short course radiotherapy preoperatively and 86 cases of them were performed on Gambee's esophagogastrectomy,one case laparotomy after radiotherapy from Feb.1993 to Dec.1994(groupⅠ).99 cases of esophageal cancer were performed on esophagectomy as controls at the same period(groupⅡ).The radiotherapy methods were 5 fractions per week and 5GY per fraction with a total dose of 20～25GY.All the patients recieved operation on the day of the 1～7 days after radiotherapy respectively.Results:All the patients tolerated the radiotherapy.The size of the tumors were decreased compared with the diameter of radiology evidences.There were no significant difference between groupⅠand Ⅱ on the operative time bleeding and postoperative complications.The resected rates were 99% in groupⅠand 89% in groupⅡ(p<005);The operative mortalities were 0 in groupⅠand 2% in groupⅡ.The postoperative oneyear survival rates were 68.6%(Ⅰ)and 64.8%(Ⅱ),2year 50.0%(Ⅰ)and 466%(Ⅱ)and 3year 469%(Ⅰ)and 37.5%(Ⅱ),respectively.