淋巴结阳性胸段食管鳞癌术后放化疗临床研究

Clinical study of postoperative chemoradiotherapy of thoracic esophageal squamous cell carcinoma with positive lymph nodes

目的对淋巴结阳性胸段食管鳞癌术后放化疗与术后放疗进行回顾性分析，观察其疗效和不良反应。方法选择首程治疗行胸段食管鳞癌三野淋巴结清扫根治术，术后病理有淋巴结转移、无远处转移患者304例，其中术后放疗组140例，术后放化疗组164例。术后放疗剂量50Gy，化疗方案为顺铂加紫杉醇，21d为1个周期，平均2．35个周期／例。结果术后放化疗组和术后放疗组3年总生存率、无瘤生存率分别为65．7％和52．8％（χ^2=6．90，P=0．009）、62．5％和52．8％（χ^2=4．75，P=0．029）；锁骨上区淋巴结转移率、远处转移率、总复发转移率分别为1．8％和7．1％（χ^2=5．21，P=0．022）、18．3％和27．9％（χ^2=3．94，P=0．047）、27．4％和39．3％（χ^2=4．80，P=0．028）；早期不良反应的中性粒细胞减少、放射性食管炎、胃肠道反应分别为96．3％和32．1％（χ^2=140．31，P=0．000）、37．2％和26．4％（χ^2=4．01，P=0．045）、23．2％和5．0％（0=19．77，P=0．000）；晚期不良反应分别为6．1％和5．0％（χ^2=0．17，P=0．678）。结论淋巴结阳性胸段食管鳞癌术后放化疗能提高生存率和无瘤生存率，降低锁骨上区淋巴结转移率、远处转移率和总复发转移率，早期不良反应重于单纯术后放疗，但患者能耐受治疗。

Objective To retrospectively analyze the treatment results and side effects of postoperative chemoradiotherapy and postoperative radiotherapy of thoracic esophageal squamous cell carcinoma （EPC） with positive lymph nodes. Methods Three hundred and four patients of thoracic EPC were initially treated with three-field lymphadenectomy, with pathological positive lymph nodes and without distant metastases; and randomly divided into two groups： 140 patients of the simple postoperative radiotherapy （RT） and 164 patients of postoperative chemoradiotherapy （CRT）. The median total dose was 50 Gy. The regimen of concurrent chemotherapy included cisplatin and taxol, and the intermission was 21 days;the median cycles were 2. 35. Results The 3-year overall survival rates were 65.7% of CRT and 52. 8% of RT （χ^2 =6. 90,P =0. 009）, and The 3-year disease-free survival rates were 62. 5% of CRT and 52. 8% of RT （χ^2=4. 75 ,P = 0. 029）. The incidences of the supraclavicular lymph-node metastases were 1.8% and 7. 1% （ χ^2 = 5. 21, P = 0. 022 ）, respectively; and the incidences of distant metastases were 18.3% and 27.9% （ χ^2 = 3.94, P = 0. 047 ）, respectively; and the incidences of overall metastases and recurrences were 27. 4% and 39. 3% （ χ^2 = 4. 80, P = 0. 028 ）, respectively. Early side effects included granulopenia （96. 3 % and 32. 1% , χ^2 = 140. 31, P = 0. 000）, radiation-induced esophagitis （ 37. 2% and 26.4% ,χ^2 =4. 01 ,P =0. 045） ,and gastrointestinal toxicity （23.2% and 5.0% ,χ^2= 19. 77,P =0. 000）. Late side effects were 6. 1% and 5.0% （χ^2 = 0. 17,P = 0. 678）, respectively. Conclusions Postoperative chemoradiotherapy of thoracic EPC with positive lymph nodes can improve the overall survival and diseasefree survival, decrease the incidence of the supraclavicular metastases, the distant metastases, the total metastases and recurrences. More severe early side effects were observed in chemoradiotherapy than in the radiotherapy group, but well tolerated.