58例胸段食管癌三维适形放疗长期疗效分析

Analysis the long-term effect of 58 patients with esophageal carcinoma treated by three dimensional conformal radiation therapy

目的探讨三维适形放射治疗(3DCRT)食管癌的长期疗效及其影响预后的因素。方法回顾性分析新疆医科大学附属肿瘤医院2003-2007年58例接受3DCRT的食管癌患者的临床资料,其中单纯放疗23例,序贯放化疗35例,临床分期为Ⅱ期24例,Ⅲ期34例。观察近期疗效、局部控制率、生存率。采用Kaplan Meier法计算局部控制率和生存率等,预后影响因素行Logrank单因素分析和Cox法多因素分析。结果随访率为96.6%,随访满7a者7例。全组患者治疗后总有效率(CR+PR)为93.1%。1、3、5、7a局部控制率分别为78%、61%、48%、39%。1、3、5、7a生存率分别为77.6%、46.6%、22.4%、12.1%。单因素预后分析显示,治疗前进食情况、病变部位、病变长度、临床分期、照射剂量为影响生存的因素(χ2=6.723、5.594、8.986、29.375、5.883,P=0.010、0.008、0.029、0.000、0.015);多因素预后分析显示,临床分期、治疗前进食情况、照射剂量是影响患者生存的独立因素(χ2=23.899、9.087、5.090,P=0.000、0.003、0.024)。结论食管癌3DCRT后局部控制率和长期生存率可以提高。治疗前进食情况、临床分期和照射总剂量为其预后影响因素。

Objective To observe the clinical effects and prognostic factors of Esophageal Carcinoma treated by three dimensional conformal Radiation therapy（3DCRT）.Methods Fifty eight patients with esophageal carcinoma,who received radical 3DCRT between Jul 2003 and Jan 2007,were included in the study.Of them,23 patients received radiotherapy alone,35 patients received sequential chemorediotherapy,Ⅱ stage 24,Ⅲ stage 34.The long term effect,1,3,5,7-year local regionalcontrol rates and survival rates were in-vestigated.The local regional control rates and survival were calculated by the Kaplan-Meier method.Uni-variate prognostic factor was analyzed by Longrank method.Multivariate prognostic factor was analyzed u-sing Cox model.Results The follow-up rate was 96.6%.The numbers of patients followed-up with 7 years was 7.Immediate response rate（CR＋PR）was 93.1%.The 1,3,5 and 7-year local control rates were 78%,61%,48% and 39% respectively.The 1,3,5 and 7-year survival rates were 77.6%,46.6%, 22.4%,12.1% respectively.Longrank analysis showed swallow embarrassment before treatment,tumor location,tumour length,clinical stage and Irradiation dose were prognostic factors for the survival（χ2=6.723,5.594,8.986,29.375,5.883,P=0.010,0.008,0.029,0.000,0.015）.Multivariate analysis showed clinical stage,swallow embarrassment before treatment and Irradiation dose were important influential factors for the survival.Conclusion 3DCRT can improve local control rate and the survival rate with ac-ceptable side effects.Clinical stage,swallow embarrassment before treatment and Irradiation dose were prognostic factors for the survival.