食管癌术前放疗的远期疗效分析

A randomized clinical study of long term efficacy of preoperative radiotherapy for esophageal cancer

目的：探讨食管癌术前放疗对手术切除率和远期疗效的影响。方法：200例食管癌病人,随机分成两组，A组：100例接受单纯手术；B组：100例接受术前放疗,2～4周后手术。所有病例接受术后随防,平均52个月。结果：A，B组间切除率，5、10年生存率无显著差异。B组胸上段食管癌切除率、10年生存率高于A组，分别为95％vs76％(P=0.0210)；33.58％vs17.24％(P=0.0274)。B组胸下段食管癌切除率、10年生存率低于A组，分别为85％vs100％(P=0.0370)；19.23％vs38.29％(P=0.0390)。术前放疗性别、年龄、大体类型、病程及病灶长度对疗效的差异无显著性。结论：术前放疗能提高胸上段食管癌的手术切除率和远期生存率；而胸下段食管癌患者尽量避免术前放疗。

Objective： To explore effect of the long term efficacy of preoperative radiotherapy for esophageal cancer. Methods： A total of 200 cases of esophageal cancer were divided randomly assigned into 2 groups： 100 cases have received operation alone (group A), and the other 100 cases have received preoperative radiotherapy 2～ 4 weeks before operation(group B). All patients were followed up with a mean time of 52 months. Results： There were no significant difference for resection rate, as well as 5 and 10 year survival rates between group A and B. The resection rate of upper third thoracic esophageal cancer in group B was higher than that in group A (95％ vs 76％ , P=0.0210), so was their 10 year survival rates (33.58％ vs 17.24％ , P=0.0274). While, the resection rate of the lower third thoracic esophageal cancer in group B was lower than that in group A (85％ vs 100％ , P=0.0370), so was their 10 year survival rates (19.23％ vs 38.29％ , P=0.0390). Preoperative radiotherapy did not induce survival difference in patients of esophageal cancer with different age, sex, gloss types, course of symptoms and length of lesion. Conclusion： Preoperative radiotherapy can significantly improve the resection rate and long term prognosis of the upper third thoracic esophageal cancer, while for the lower third thoracic esophageal cancer, it is better to avoid preoperative radiotherapy.