食管癌三维适形放疗与放化疗的疗效比较

ANALYSIS OF PROGNOSIS ON ESOPHAGEAL CARCINOMA PATIENTS WITH THREE-DIMENSIONAL CONFORMAL RADIOTHERAPY (3D-CRT) ALONE OR RADIOTHERAPY COMBINED WITH CHEMOTHERAPY

目的比较食管癌三维适形放疗与放化疗的疗效。方法回顾性分析2001年1月—2007年8月接受三维适形放疗的184例食管癌患者的临床资料,其中118例行单纯放疗(单放组)、66例放疗联合化疗(放化组),比较2组疗效及预后因素。结果单放组和放化组比较,CT显示食管肿瘤最大直径差异有统计学意义(P<0.05);而性别、年龄、病变部位、食管造影病变长度、放疗前进食状况、T分期、N分期、M分期、临床分期和放疗剂量均差异均无统计学意义(P>0.05)。全组放疗后完全缓解61例、部分缓解112例、未缓解11例,总有效率(完全缓解+部分缓解)为94.02%;放化组近期疗效优于单放组(P<0.05),2组放射性食管炎和肺炎发生率差异无统计学意义(P>0.05)。全组1、3、4年生存率分别为64.67%、33.77%和26.64%;中位生存期18.7个月。单放组与放化组比较生存率差异无统计学意义(P>0.05);但化疗>2周期者预后好于化疗1～2周期和未化疗者(P<0.05)。年龄>63岁者放化组生存率明显高于单放组,而T_(3～4)期放化组生存率低于单放组(P<0.05);颈及胸上段癌、T_(1～2)、N_0期、Ⅰ～Ⅱ期和放疗剂量≤64Gy组放化组生存率高于单放组,但差异无统计学意义(P>0.05);年龄≤63岁、放疗剂量>64Gy、胸中下段癌、N_、Ⅲ～Ⅳ期、性别、食管造影显示病变长度和CT显示瘤体最大直径,放化组和单放组比较生存率差异无统计学意义(P>0.05)。结论食管癌三维适形放疗联合化疗2周期以上者可以提高局控率和生存率,而化疗1～2周期者未能获益;年龄较大者,三维适形放疗加化疗可以提高生存率;颈及胸上段癌、早期和放疗剂量较低者放化疗有提高生存率的趋势。

Objective To explore the prognosis of esophageal carcinoma patients which treated with three - dimensional conformal radiotherapy （3D - CRT） alone or radiotherapy combined with chemotherapy. Methods From January 2001 to August 2007,184 patients of esophageal carcinoma were treated with 3D - CRT alone（ group of RT） or radiotherapy combined with chemotherapy（ group of CRT）. Survival rates and its related prognostic factors were evaluated retrospectively with SPSS11.5 software. Results Between RT group and CRT group, there was significant difference for the largest diameter of lesion in CT scanning image （ P 〈 0.05 ） ; and there were no significant differences for gender, ages, site of lesion,lesion length in barium esophagogram, diet before radiotherapy, T, N, M and clinical stage, and dose of radiotherapy （ P 〉 0.05 ）. After radiotheraov, eomolete （CR） in 61. nartial remission （ PR ） in 112and no remission（NR） in 11 patients,the rate of total efficiency（ CR ＋ PR）was 94.02%. Recent efficacy was significantly higher in CRT group than in RT group （P 〈 0.05 ） ;but radiation induced esophagitis and pneumonitis was not different（P 〉0.05）. Survival rates of 1,3,4 - years and median time was 64.67%, 33.77% ,26.64% and 18.7 months respectively. Survival rate was not different between CRT group and RT group ; but survival rate was significantly higher in patients with 〉 2 cycles of chemotherapy than with 1 - 2 cycles of chemotherapy and RT alone （ P 〈 0.05 ）. In patients with ages 〉 63 years, survival rates was significantly higher in CRT group than in RT group;but in patients with T3-4 stage, survival rates was significantly lower in CRT group than in RT group （P 〈 O. 05 ）. In patients with cervical and upperthoracic esophageal cancer,T1-2, No, I- II stage and dose of ≤ 64Gy, survival rates was higher in C RT group than in RT 64Gy, middle and group but showed no significant difference （ P 〉 0.05 ）. In patients with ages≤63, 〉 lower - thoracic esophageal cancer, N1-2, Ⅲ-IV stage, gender,lesion length in barium esophagogram （≤5cm/〉 5cm）and the largest diameter of lesion in CT scanning image, survival rate were not significantly different between CRT group and RT group （P 〉 0. 05 ）. Conehmion In patients of esophageal carcinoma, 3D - CRT combined with more than 2 cycles of chemotherapy could improve survival rate. 3D - CRT combined with chemotherapy could improve survival in elder patients. 3D - CRT combined with chemotherapy may have the potential to improve survival rate in patients with upper - thoracic esophageal cancer, early stage and lower dose of radiotheraov.