食管癌术后放疗靶区的确定

Postoperative radiotherapy target volume of esophageal cancer

目的探讨食管癌术后淋巴结转移的规律以明确术后放疗靶区。方法回顾性分析2006～2009年我科收治的147例食管癌术后淋巴结转移患者的转移分布情况。结果锁骨上区,上纵隔,中纵隔,下纵隔,腹腔淋巴结转移及吻合口复发发生率分别为36.73%,55.78%,7.48%,0.68%,5.44%,10.88%,食管上中段,食管下段癌锁骨上淋巴结转移发生率分别为36.07%（44/122）,40%（10/25）,差异无显著性（χ^2=0.138,P〉0.05）,上纵膈淋巴结转移发生率分别为59.84%（73/122）,36%（9/25）,差异有显著性（χ^2=4.779,P〈0.05）。结论建议食管癌肿瘤术后放疗的靶区包括锁骨上区及上纵隔、吻合口和食管瘤床。

Aim To study the characteristics of lymph node metastases after radical surgery and to confirm postoperative radiotherapy target volume for esophageal cancer.Methods We reviewed lymph node metastases after esophagectomy in 147 cases of esophageal cancer in department of radiation oncology in the First Affiliated Hosipital of Anhui Medical University between 2006 and 2009.Results Metas-tases to supraclavicular,upper mediastinal,middle mediastinal,lower mediastinal,abdominal nodes and anastomotic stoma were ob-served in 36.73%,55.78%,7.48%,0.68%,5.44%,and 10.88%,respectively.The rates of supraclavicular lymph node metastases for the upper-middle and lower esophagus were 36.07%（44 /122）,and 40%（10 /25）.The difference wasn’t significant.The rates of upper mediastinal lymph node metastases for the upper-middle and lower esophagus were 59.84%（73 /122）,and 36%（9 /25）,respec-tively.The difference was significant.Conclusion Postoperative radiotherapy target volume for esophageal cancer was suggested to con-clude supraclavicular,upper mediastinal,anastomotic stoma and esophageal tumor bed.