41例老年食管癌的临床特点和放疗疗效观察

Study of clinical characteristic and value of radiotherapy for 41 elderly patients with esophageal cancer

目的探讨70岁以上老年食管癌的临床特点和放疗疗效及耐受性。方法收集2004年1月至2006年5月41例70岁以上单纯放疗的老年食管癌患者的完整临床病理资料,包括首发症状、病变部位、病变长度、临床分期和合并症情况。全组25例行常规放疗,16例行三维适形放疗(3-DCRT),均采用常规分割,放疗剂量为60～70Gy。结果41例老年食管癌患者中,进食梗阻为首发症状的占73.2%,胸下段占43.9%,病变长度>5cm占58.5%;按非手术治疗食管癌的临床分期:Ⅰ期17例,Ⅱ期16例,Ⅲ期8例;合并其他慢性疾病的占65.9%,合并两种以上的占51.2%。全组近期有效率为87.8%(36/41);KPS评分提高占73.2%;未发生3级以上不良反应;1、3年生存率为分别51.2%和17.1%。结论进食梗阻仍是老年食管癌的首发症状,胸下段病变多见,病变长度长,合并症多见;放射治疗近期疗效及耐受性好,患者生活质量提高,是70岁以上老年食管癌的有效治疗手段之一。

Objective To discuss the clinical characteristic and explore the therapeutic efficacy and toxicity of radiotherapy for esophageal cancer in elderly patients.Methods Forty-one patients over 70 years with esophageal cancer were treated by radiotherapy from January,2004 to May,2006.First symptom,position,length,clinical stage and the other chronic diseases was discussed.Twenty-five patients received conventional radiotherapy and the other the 16 patients received 3-DCRT.The overall received routine division 60-70Gy.Results 73.2% of the first symptom was obstruction.43.9% cases were lower-thoracic esophageal cancer.Focus length of 58.5% cases was more than 5cm.There were 17 cases of clinical stageⅠ,16 of stage Ⅱ and 8 of stage Ⅲ.65.9% cases were accompanied by other chronic diseases,and 51.2% were accompanied by more than two diseases.The total dose was 60 to 70 Gy.The overall response rate was 87.8%（36/41）.73.2% patients improved in Karnofsky（KPS） performance status.Adverse events over grade 3 were not observed.The overall 1-,3-year survival rates were 51.2% and 17.1%.Conclusion The first symptom was obstruction,the lower-thoracic esophageal cancer was common,the focus was long,and the other chronic diseases were ordinary.Radiotherapy has good response in the near future.The KPS was prominent improved.The early interference and actively treated the other chronic diseases;radiotherapy was tolerant and effective for patients aged 70 and older with esophageal cancer.