三维适形放疗结合金属支架置入治疗中晚期食管癌吞咽困难的临床研究

Three-dimensional conformal radiotherapy combined with metal stent for dysphagia in advanced esophageal carcinoma

目的探讨治疗晚期食管癌吞咽困难有效的治疗模式。方法回顾了在肿瘤中心治疗超过5年时间内所有食管癌患者的临床资料,对所有针对恶性吞咽困难接受姑息治疗的患者进行了数据统计,采用Wilcoxon符号秩检验,以确定意义(P<0.05)。结果 80例不能手术的食管癌患者吞咽困难的行姑息治疗。主要治疗方式是放射治疗,占患者总数的66%,金属支架置入占21%和放疗结合支架占13%。治疗平均时间:支架置入组为1d,放射治疗组为40d(P=0.001)。最初由支架治疗的患者,82%的患者吞咽困难在治疗2周之内改善(吞咽困难评分为0或1),18%的患者在10周的治疗后复发吞咽困难。在放射治疗组,缓解发病较慢,只有50%的患者在第2周得到满意的缓解(吞咽困难评分0或1),缓解无复发的效果稳定,在10周90%的患者吞咽困难评分为0或1。放射治疗和金属支架置入联合治疗组,吞咽困难指数达到1或0的患者,在第2周就占86%;到第10周,吞咽困难指数1或0的患者占92%。结论对于不能手术的食管癌患者,放射治疗可提供持久的吞咽困难缓解效果,但治疗时间偏长和达到满意缓解的时间较为滞后。另一方面,支架提供更迅速和更有效的及时缓解,但难以长期保持。放射治疗和金属支架置入相联合,可以加快缓解时间并达到稳定缓解的效果。

Objective The palliation of dysphagia in metastatic esophageal cancer remains a challenge,and the optimal approach for this difficult clinical scenario is not clear.We therefore sought to define and determine the efficacy of various treatment options used at our institution for this condition.Methods Methods We reviewed a prospective database for all patients managed in an esophageal cancer referral centre over a 5-year period.All patients receiving palliation of malignant dysphagia were reviewed for demographics,palliative treatment modalities,complications,and dysphagia scores（0=none to 4=complete）.The Wilcoxon signed rank test was used to determine significance（P0.05）.Results During 2005～2010,80patients with inoperable esophageal cancer were treated for palliation of dysphagia.The primary treatment was radiotherapy in 66%,metal stenting in 21% and radiotherapy combined with stent in 13%.Mean duration of treatment was 1day in he stent group and 40days in the radiotherapy group（P=0.001）.In patients treated initially by stenting,dysphagia improved within 2weeks of treatment in 82% of patients（dysphagia score of 0or 1）.However,18% of patients presented with recurrence of dysphagia at 10weeks of treatment.In the radiotherapy group,the onset of palliation was slower,with only 50% of patients palliated at 2weeks（dysphagia score of 0or 1）.However,long-term palliation was more satisfactory,with 90%of patients remaining palliated after 10weeks of treatment.Conclusion In inoperable esophageal cancer at our centre,radiation treatment provided durable long-term relief,but came at a high price of a long wait time for initiation of treatment and a long lag time between initiation of treatment and relief of symptoms.On the other hand,stenting provided more rapid and effective early relief from symptoms,but was affected by recurrence of dysphagia in the long-term.