食管癌根治术后调强辅助放疗的临床疗效

Effect of IMRT in patients with esophageal cancer after surgery

目的:探讨食管癌根治术后调强辅助放疗的近期疗效和副作用。方法:回顾分析41例术后调强辅助放疗食管癌患者的临床资料,数据用SPSS 17统计软件处理,分析1、2年的生存率、复发率、转移率的影响因素及治疗副作用。结果:全组1、2年的生存率分别是79%、51%,复发率是43%、70%,转移率是47%、72%。主要副作用为轻度(Ⅰ、Ⅱ级)毒性,消化道反应占75.7%,呼吸道反应占29.2%,白细胞计数下降占75.6%,贫血占31.7%,血小板减少占7.3%。单因素分析显示,放化疗前CT分期、术后淋巴结转移个数、放疗剂量与生存率密切相关;多因素分析显示,术中有无癌性浸润是转移率的影响因素(χ2=4.12,P=0.04)。结论:食管癌术后调强辅助放疗可提高肿瘤局部控制率,但未显示出短期生存优势。虽有较高的消化道毒性,但可耐受。术中有无癌性浸润是转移率影响因素。

Objective： To inestigate the term effect and side effect of intensity modulated radiation therapy in patients accepted esophageal resection. Methods： The clinical date of 41 patients accepted esophageal resection were reviewed and analyzed by SPSS17. The survival rate, the recurrence rate, the rate of distant metastasis were calculated for the first and second year. Influencing factors and treatment side effects were observed. Results： For the first and second year,the survived rate for the whole group were 79% and 51%, the recurrence rate was 43% and 70%, the metastasis rate was 47% and 72%. The main side effects were mild toxicity （ I ,II grade）： gastrointestinal reactions（ 75.7% ）, respiratory reaction （ 29.3% ）, white blood cell count decreased （ 75.6% ）, anemia（31.7% ）, thrombocytopenia（7.3% ）. Univariate analysis showed that survival rate was closely related to whether there was infiltration by preoperation CT scan, the number of postoperative lymph node metastasis and the radiation dose. Multivariate analysis showed that carcinomatous infiltration existed or not during the operation was influencing factor of metastasis rate（x2 = 4. 12, P = O. 04 ）. Conclusion： IMRI after esophageal cancer radical surgery can improve the local control rate, but have no short-term survival advantage. Although higher gastrointestinal toxicity, but can be tolerated. Carcinomatous infiltration existed or not during the operation is influencing factor of metastasis rate.