淋巴结阳性中老年胸段食管鳞癌术后放疗价值

The value of thoracic esophageal squamous cell carcinoma after radiotherapy in the elderly positive lymph node

目的分析中老年淋巴结转移阳性胸段食管鳞癌术后放疗疗效和毒副反应。方法选择1993年1月-2007年3月我院收治的55岁以上淋巴结转移阳性胸段食管鳞癌三野根治术患者469例,其中单纯手术318例,术后放疗151例。术后3~4周开始放疗,中位总剂量50 Gy,分25次,2 Gy/次,5次/周,5周完成。结果全组1、3、5年生存率分别为79.3%、44.2%、27.0%,中位生存时间30.5个月,其中单纯手术和术后放疗的5年生存率分别为24.9%和37.7%（χ2=4.747,P〈0.05）;在术后放疗组中年龄≤60岁与年龄。〉60岁患者5年生存率分别为33.4%对29.3%（χ2=0.789,P〉0.05）。早期放疗反应为消化道反应29.8%、气管炎22.5%、白细胞降低占37.7%,多数患者能耐受,有2例死于晚期放疗并发症。结论术后放疗能提高淋巴结转移阳性中老年胸段食管鳞癌三野根治术后患者的生存率,毒副反应患者能耐受。

[ Objective ] To analysis the elderly positive lymph node metastasis and toxicity of thoracic esophageal squamous cell carcinoma after radiotherapy. [ Methods ] Select 469 positive lymph node metastasis of thoracic esophageal squamous cell carcinoma patients over the age of 55 in our hospital from 1993 January to 2007 March through the treatment of radical operation of Sanye, including simple operation in 318 cases, 151 cases of postoperative radiotherapy. Start radiotherapy 3 to 4 weeks after operation, the median total dose 50Gy, 25 times, 2Gy each time, 5 times/week, for 5 weeks. [ Resluts ] The overall 1-year, 3-year and 5-year survival rates were 79.3%, 44.2%, 27%. The median survival time was 30.5 months. The 5-year survival rates of receiving simple operation and postoperative radiotherapy were 24.9% and 37.7% respectively （2＇2=4.747, P〈 0.05）; The 5-year survival rate of postoperative radiotherapy in the age group of/ under 60 years was 33.4%. The 5-year survival rate in patients over 60 years was 29.3% （;（2=0.789, P〉 0.05）. Early responses to radiotherapy are 29.8% gastrointestinal reaction, 22.5% tracheitis and 37.7% leukopenia. Most patients could endure. There were 2 cases of dying of lications of radiotherapy. [ Conclusion ] Postoperative radiotherapy can improve the survival rate of positive lymph node metastasis of thoracic esophageal squamous cell carcinoma patients after the treatment of radical operation of Sanye. Adverse reaction can be tolerated.