食管癌适形调强放疗累及野和扩大野的比较研究

Comparison of involved field radiotherapy and extended field radiotherapy of definitive radiotherapy in patients with esophageal squamous cell carcinoma

目的:回顾性分析食管癌不同临床靶体积对适形调强放射治疗疗效及失败模式的影响,探讨不进行淋巴结预防照射是否可行。方法:2007年1月至2011年6月本院收治行根治性三维适形放疗(3 dimensional conformal radiotherapy,3D-CRT)/调强放疗(intensity modulated radiation therapy,IMRT)的食管鳞状细胞癌患者共68例,根据CTV范围不同分成淋巴结累及野组(累及野组)和淋巴结扩大野组(扩大野组)。结果:累及野组和扩大野组1、2年的生存率分别为59%、41%和61%、39%(P=0.56),局部控制率分别为66%、48%和68%、49%(P=0.78)。累及野组和扩大野组总失败率分别为63%和66%(P=0.89),局部失败率为53%和59%,远处转移失败率分别为47%和44%,区域失败率分别为11.8%和7.5%,两者比较差异无统计学意义(P=0.39)。扩大野组肺V10、V20、V30及肺平均受量等指标均大于累及野组,其中V10和肺平均剂量比较差异有统计学意义。结论:累及野组在生存率、局部控制率方面和扩大野组相似,野内复发和远处转移是治疗失败的主要原因,局部晚期食管癌患者行累及野放疗是安全的。

Objective： To retrospectively analyze the treatment effect and the patterns of failure associated with different clinical target volume on patients with esophageal cancer treated with three dimensional conformal or intensity modulated radiotherapy, and to determine whether involved field radiotherapy is practicable in these patients. Methods： A total of 68 patients with esophageal squa- mous cell carcinoma between January 2007 to June 2011 in our hospital underwent three dimensional conformal or intensity modulated radiotherapy, according to the CTV range is divided into lymph involved-field group （involved field group） and lymph extended field group （extended field group）. Results： In Involved field group and expand field group the survival rate of 1, 2 years were 59%, 41% and 61%, 39% respectively （P^0.56）, and local control rates were 66%, 48% and 68%, 49% respectively（P=0.78）. The total failure rates of involved field and the expand field were 63% and 66% （P=0.89）. The local failure rate was 53% and 59%, distant metastasis failure rates were 47% and 44%, the regional failure rates were 11.8% and 7.5% in Involved field and the expand field, there were no difference in Statistics （P=0.39）. The lung V10, V20, V30 and mean lung dose of extended field group were greater than that of the in- volved field group, while the mean lung dose and V10 has statistical difference. Conclusion： The involved field group was similar as the extended field group in the survival rate and local control rate, the regional recurrence and distant metastasis are the main cause of treatment failure, so the involved field radiotherapy is feasible for locally advanced esophageal carcinoma.