209例食管癌三维适形放疗疗效分析

Three - dimensional conformal radiotherapy （ 3DCRT ） for 209 patients with esophageal carcinoma

目的探讨食管癌三维适形放疗（3DCRT）的疗效及其预后相关因素。方法回顾性分析2001-2007年接受3DCRT的209例食管癌患者的临床资料，分析局部控制率、生存率及预后影响因素。结果随访截至2008年12月，随访率为98．1％。随访满1、3、4、5年者分别为209、131、95、56例。1、3、4年局部控制率分别为74．9％、50．4％、45．8％，生存率分别为64．6％、30．8％、23．6％，中位生存期18个月。单因素分析预后影响因素有疗前进食情况、原发肿瘤部位、食管造影显示病变长度、CT显示病变长度和瘤体最大直径、T分期、N分期、临床分期、近期疗效、急性放射性食管炎；而性别、年龄和放疗剂量大小与预后无关。Cox多因素分析显示疗前进食状况、原发肿瘤部位、临床分期、照射方式（全程或后半程3DCRT）为独立预后影响因素。结论食管癌3DCRT安全有效，放疗前进食梗阻轻、临床分期越早，3DCRT预后越好，反之预后越差；颈胸上段癌预后好于胸中下段癌，全程3DCRT预后好于后半程3DCRT。

Objective To analyze the outcomes and prognostic factors of esophageal carcinoma treated with three-dimensional conformal radiotherapy （3DCRT）. Methods From January 2001 to August 2007, 209 patients with esophageal carcinoma treated with 3DCRT were retrospectively analyzed. The local control rates, the survival rates and the related prognostic factors were evaluated with SPSS 11.5 software. Results The follow-up rate was 98.1% by December 2008. The number of patients followed up for 1,3, 4 and 5 years was 209,131,95 and 56, respectively. The 1-, 3- and 4-year local control rates were 74. 9% , 50.4% and 45.8% , respectively. The 1-, 3-and 4-year overall survival rates were 64. 6% , 30. 8% and 23.6%, respectively, with a median survival time of 18 months. Univariate analysis showed that the significant prognostic factors included the degree of dysphagia, tumor site, lesion length in barium esophagogram and CT image, the largest diameter of lesion in CT image, T stage, N stage, clinical TNM stage, short term effect, and degree of acute esophagitis. Multivariate analysis revealed that the degree of dysphagia, primary tumor site, clinical stage, and radiotherapy technique （3DCRT or late half course 3DCRT） were independent prognostic factors. Conclusions Three-dimensional conformal radiotherapy is effective and feasible in the treatment of esophageal cancer. The degree of dysphagia, primary tumor site, and clinical stage are independent prognostic factors for survival of patients treated with 3DCRT.