32例食管癌放射治疗后死亡的尸检分析

Autopsy finding in 32 cases treated by external beam radiotherapy alone for esophageal carcinoma

目的 分析放射治疗后食管癌的死亡原因 ,提高对非肿瘤性穿孔的认识及治疗。方法 回顾性分析本院行放射治疗的食管癌死亡并有完整尸检资料病例 32例。一程放射治疗 2 6例 ,二程放射治疗 6例。放射治疗总剂量 6～ 2 0 0Gy。结果 局部无癌占 2 8.1% ,肿瘤残存占 71.9%。总剂量 41～ 5 9、6 0～ 80Gy局部无癌分别占 5 / 9、3/ 9,肿瘤残存分别占 13.0 %、47.8%。单次剂量 <180、180～ 2 10、>2 10cGy无肿瘤残存分别占 2 / 9、3/ 9、4/ 9,肿瘤残存分别占 5 2 .2 %、39.1%、8.7%。穿孔周围组织中有大量的急慢性炎性细胞浸润 ,甚至有脓腔的形成及纤维素的段裂。淋巴结转移占 46 .9%。上段食管癌隔下淋巴结转移占 5 0 .0 % ,下段食管癌隔下淋巴结转移占 12 .5 %。全身脏器转移率为37.5 %。以穿孔死亡为主要原因占 75 .0 % ,其中无肿瘤穿孔死亡占 33.3% ,以食管主动脉瘘为主占6 2 .5 %。全组无 5年生存。 1、3年生存率分别为 15 .6 % (5 / 32 )、3.1% (1/ 32 )。结论 食管癌放射治疗后以局部复发造成的食管穿孔死亡为主 ,但要警惕有一部分病例 。

Objective To analyze the death reason of esophageal carcinoma treated by external beam radiotherapy alone, and to enrich knowledge of perforation without evidence of residual tumor at the primary site.Methods Thirty two esophageal carcinoma patients who had been treated from 1958 to 1985 by radiotherapy alone were autopsied. This paper presents the findings from their complete records ,which includes 26 patients with the first course of treatment and 6 second course. The total doses ranged from 6～200 Gy.Results On autopsy, 28.1% of patients did not have any residual tumor at the primany site,but 71.9% of patients did have persistent tumor locally. The incidences of disease free patients in relation to the total dose were: 41 to 59 Gy—5/9 and 60 to 80 Gy—3/9 while those having persistent tumor on these two dose levels were 13.0% and 47.8%. The incidence of disease free patients in relation to the size of each radiation fraction were<180 cGy —2/9,180～210 cGy —3/9 and >210 cGy —4/9 while those with persistent tumor on these three dose levels were 52.2%, 39.1% and 8.7%. Pathologically,extensive inflammatory infilfration was observed in the peri perforation tissues with abscess formation.Fragmentation of fibrils was observed. Of all cases,46.9% had lymph node metastasis, 50% of the upper segment lesions developed subdiaphragmatic lymphatic metastasis in contrast to 12.5% from lesion in the lower segment. Generalized metastases were present in 37.5% of cases. 75.0% of patients died chiefly of perforation, among whom 33.3% did so of disease free perforation. Esophago aortic fistula observed frequently was most deadly. No one among these 32 patients had survived over five years but their 1 and 3 year survival rates were 15.6%(5/32) and 3.1%(1/32).Conclusions The couse of death after receiving radiotherapy for esophageal carcinoma is due to local persistent tumor leading to perforation. Yet ,one must be aware of death due to non cancerous perforation which may be due to infection and abscess formation.