食管癌术后局部复发再次治疗的疗效观察

Therapeutic effect for local recurrence after curative resection of esophageal carcinoma

目的 食管癌根治术后约一半患者复发,复发后影响生存的因素大多数是未知的.文中比较食管癌术后病理示淋巴结阳性与阴性局部复发后再次治疗的临床疗效.方法 回顾性分析食管癌术后局部复发后行放化疗的86例患者,术后病理示淋巴结阳性与淋巴结阴性各43例,术后复发时间为1～72个月,均行三维适形放疗,剂量为60～66Gy,联合化疗4～6周期.结果 随访率为100%,2组局部复发再次治疗后的1、2、3年生存率分别为67.4%、23.3%、4.7%和90.7%、60.5%、32.6%,2组1、2、3年生存率比较差异均有统计学意义（P〈0.05）.结论 食管癌术后复发病例中,术后病理示淋巴结阴性局部复发后治疗疗效优于术后病理示淋巴结阳性局部复发患者.

Objective Approximately half the patients developed postoperative recurrence after curative resection for esopha- geal cancers. Factors affecting survival after such recurrence remain largely unknown. The present study compared the therapeutic effect of local recurrence after curative resection of esophageal cancer with positive and negative pathological lymph node. Methods Retrospective analysis was made to 86 patients receiving radiotherapy and chemotherapy for local recurrence after resection of esophage- al carcinoma. They were divided into 2 groups, each containing 43 cases, group A ： lymph node positive ; group B ： lymph node nega- tive. Recurrence developed in 1 - 72 months after the resection. All were treated with three-dimensional eonformal radiotherapy of 60 - 66Gy, combining with chemotherapy of 4 -6 cycle. Results The follow-up rate was 100% , 1, 2 and 3 year survival rates were 67.4%, 23.3%, 4.7% and 90.7%, 60.5%, 32.6% respectively in group A and B, the difference was significant（P 〈 0. 005）. Conclusion The therapeutic effect was better for lymph nodes negative than that of lymph node positive patients after local recurrence following resection of esophageal cancer. Lymph node positive patients required effective adjuvant therapy, while lymph node negative patients can be observed.