老年食管癌患者三维适形或调强放疗疗效及预后

Outcome and prognosis in elderly patients with esophagus cancer treated with three-dimensional conformal radiotherapy or intensity-modulated radiotherapy

目的:分析70岁以上老年食管癌患者对单纯三维适形放射治疗(3DCRT)或调强放射治疗(IMRT)技术的耐受性和近远期疗效。方法:回顾分析53例未手术仅单纯放疗的食管癌患者,年龄70-94岁,中位74岁,46例患者合并内科疾病。临床分期T1-4,均无远处转移。采用三维适形放射治疗(3DCRT)和调强放射治疗(IMRT)技术,靶区剂量范围26.1-72.9Gy,单次剂量1.8-2.2Gy。95%的计划靶区满足处方剂量。生存率采用Kaplan-Meier,组间生存率比较采用Log rank检验,组间率的比较采用χ2检验。结果:88.7%的患者完成治疗剂量,88.2%完全缓解(CR),2年总生存率(OS)、癌症相关生存率(CSS)分别为37.4%和48.2%。与CR相关因素包括有无内科合并症、疗前血红蛋白(Hb)、肿瘤体积(GTV)、ECOG评分、T分期、有无淋巴结转移和放疗剂量。单因素分析与OS和CSS均相关的因素包括疗前Hb、ECOG评分和近期疗效,而内科合并症、GTV体积与OS相关,内科合并症中仅有无慢阻肺与CSS相关。多因素分析与二者相关的仅疗前Hb、近期疗效。结论:因内科疾病不能手术老年患者,单纯3DCRT或IMRT放疗耐受性好,近远期疗效好。影响总生存率的独立预后因素主要是完全缓解率和疗前Hb。

Objective：To analyze the outcome for patients older than 70 with esophageal cancer treated with definitive three-dimensional conformal radiotherapy（3DCRT） or intensity-modulated radiotherapy（IMRT）.Methods：Fifty-three patients（median age,74 years;ranged 70-94 years） with esophageal cancer were analyzed respectively.Forty-six patients combined with other diseases.All patients had stage I-IV without distance metastasis.All patients received 3DCRT or IMRT.The total dose for target volume was 26.1-72.9Gy at 1.8-2.2Gy per fraction daily.The prescribed dose covered at least 95% of the planning target volume.Kaplan-Meier method was used for overall survival（OS）,cause-specific survival（CSS）.Comparisons of survival between the two groups were made using the Log-rank test.Pearson χ2 test was used to compare the ratio of two groups.Results：Forty-seven（88.7%） of the 53 patients completed the treatment,and 88.2% of the patients had complete regression（CR）.The 2-year OS and CSS were 37.4% and 48.2%,respectively.The factors associated with CR were with or without medical disease,pre-radiotherapy hemoglobin level（Hb）,the volume of gross tumor,performance status,T stage,with or without lymph node metastasis,and irradiated dose.Using univariate analysis,with or without medical disease,Hb,performance status,and CR were significantly associated with OS and CSS.other diseases was associated with OS and chronic obstructive pulmonary disease（COPD） was related with CSS.Using multivariate analysis,CR and Hb were associated with OS and CSS.Conclusion：Treated with 3DCRT or IMRT alone,elder patients with other diseases had better endurance and CR.Pre-radiotherapy Hb and CR were independent prognostic factors.