213例食管癌锁上预防照射的研究

Supraclavicularpreventionradiationfor213patientswithesophagealcarcinoma

目的：探讨双锁上预防照射对治疗食管癌的意义。材料与方法：１９８８年７月－１９９２年６月对２１３例食管癌病人做了前瞻性双锁上预防照射，随机分成两组：双锁上预照组（９５例）及对照组（１１８例）。食管局部采用１０ＭＶ－ｘ线常规３野照射，总量６０Ｇｙ／６周，双锁上用Ｃｏ常规分割照射，总量５０Ｇｙ／５周。结果：双锁上预照组１，２，３年生存率似优于对照组，但无统计学差别。胸上段预照组２，３年生存率似优于对照组，但无统计学差异，胸中段７ｃｍ以上的病人２，３年生存率领照组似优干对照组，但无统计学差别。放疗期间有３％（４／１１８）的病人发生锁上淋巴结转移（胸上段１例，胸中段３例），均出现在对照组，结论：我们认为，双锁上预防照射对防止锁上淋巴结转移可能有作用，但对提高生存率未贝肯定影响，对颈段、胸上段病人应行双锁上预防照射。胸中段７ｃｍ以上的病人也可行双锁上预防照射。

purpose:Toevaluatetheeffectofsupraclavicularpreventiveradiationforpatientswithesophagealcarcinoma.MaterialsandMethods:FromJuly1988toJune1992,213patientswithesophagealcancersweretreatedwithexternalradiotherapy,Patientsweredividedintotwogroups:esophagusandsupraclavicularpreventiveradiationgroup(95cases)andcontrolgroup(esophagusradiotiononly,118cases)Theesiophagealcarcinomawastreatedwith19-MVXray.Totaldosewas6000cGy/6W,Thetotaldoseofsupraclavicularfieldswas5000cGy/5Wwith60Co,Results:Thesurvivalsof1,2and3yearinsupraclavicularpreventivegroupwasatitlebetterthanthatofcontrolgroup,buttherewasnosignificantdifferencebetweentwogroups.Twoandthreeyearsurvivalsofthepatientswithupperthoracticsegmentdiseaseinsupraclavicularpreventivegroupwereslightlybetterthanthatofcontrolgroup.TherewasnosignificantdifferenceThesurvivalofthepatientswhosetumorlengthwasover7cminmiddlethoracicsegmentwasslightlybetterthanthatofconrtolgroup.Therewassignificantdifference.3%(4/118)patientsoccuredsupraclavicularmetastasisincontrolgroupduringtreatment(1uppetthoracicsegent,3middlethoracicsegment).Conclusion:Itseemsthatsupraclavicniarpreventiveradiationmayhaveeffectivetothepreventionofsupraclavicularlymphnodemetastasis,butnotimprovethe;;urvival.Thesupraclavicularpreventiveradiationmaybetheind:cationforthepatientswithesophagealcarcinomaintheneckandupperthoracicsegmentsandinthemiddlethoracicsegmentover7cm.