三维适形放疗食管癌治疗后纵隔转移淋巴结的近期疗效观察

Three-dimensional conformal radiotherapy for mediastinal lymph node metastasis of esophageal carcinoma after treatment

目的探讨食管癌治疗后纵隔转移淋巴结三维适形放射治疗的意义和效果。方法采用三维适形放疗治疗食管癌治疗后纵隔转移淋巴结患者41例,其中术后转移36例,纵隔淋巴结转移复发平均时间为15.6月;放疗后转移5例,复发平均时间为14.5月。所有病例均采用三维适形放疗,CTV为1.8~2.0 Gy/次,5次/周,每次3~5个照射野投照,总剂量50~66 Gy。结果近期疗效：完全缓解19.5%（8/41）,部分缓解51.2%（21/41）,总有效率70.7%（29/41）。急性放射性肺炎0级22例（53.7%）,1级13例（31.7%）,2级4例（9.8%）,3级2例（4.9%）,无4级发生;急性放射性食管炎0级19例（46.3%）,1级14例（31.4%）,2级5例（12.2%）,3级3例（7.3%）,无4级发生。结论三维适形放射治疗食管癌治疗后纵隔淋巴结转移有较好的疗效,患者耐受性较好。

Objective To evaluate the application of three dimensional conformal radiotherapy（3-DCRT） for mediastinal lymph node matestasis of esophageal carcinoma after treatment.Methods Forty-one patients with mediastinal lymph node metastasis of esophageal carcinoma were enrolled in the study,including 36 patients with postoperative metastasis and the average relapse time of 15.6 months;5 patients with metastasis after radiotherapy and the relapse time of 14.5 months.All patients were treated by 3-DCRT with the dose of 50～66 Gy,1.8～2.0 Gy/fx,5fx/w and 3～5 fields/fx.Results Immediate curative effect： complete remission rate was 19.5%（8/41）,partial remission rate was 51.2%（21/41） with an overall response rate of 70.7%（29/41）.Of 41 patients,19（46.3%） developed radiation pneumonitis： grade 1 in 13 patients,grade 2 in 4 and grade 3 in 2.Acute radiation esophagitis was also observed： grade 0 in 19 patients,grade 1 in 14,grade 2 in 5 and grade 3 in 3.Conclusion Three dimensional conformal radiotherapy is effective and well tolerated for mediastinal lymphonodus matestasis of esophageal carcinoma after treatment.