胸段食管癌左胸路径手术后小T型野辅助放疗的结果分析

The outcomes of patients with thoracic esophageal carcinoma receiving T-shaped field adjuvant postoperative radiotherapy after left thoracotomy resection

目的 :观察胸段食管癌左胸路径手术后采用小T型野辅助放疗的初步结果,以明确小T型野的治疗作用及安全性。方法 :2010年1月—2011年12月上海市胸科医院放疗科收治的食管癌左胸路径根治性R0手术后患者88例。采用小T型野辅助放疗(包括双侧锁骨上区、中上纵隔和吻合口),放疗剂量为50 Gy/25次。结果 :所有患者均按计划完成治疗。15例(15/88,17%)患者出现复发转移,其中2例患者为单纯照射野内复发,2例患者为腹腔淋巴结转移,2例患者同时出现照射野内和远处转移,9例患者出现单纯远处转移。患者1、2和3年无疾病生存率分别为93.2%、80.8%和56.0%,1、2和3年总生存率分别为98.9%、84.4%和58.8%。主要不良反应为放射性肺炎、放射性食管炎、食管纤维化和放射性皮炎,无Ⅳ度以上不良反应。结论 :胸段食管癌左胸路径根治手术后采用小T型野辅助放疗后局部复发率较低,不良反应较轻,但远处转移的比例仍较高。

Objective： To investigate the effectiveness and safety of T-shaped field adjuvant postoperative radiotherapy after left thoracotomy resection for patients with thoracic esophageal carcinoma. Methods： Total of 88 patients with esophageal carcinoma receiving R0 resection of left thoracotomy from Shanghai Chest Hospital between January 2010 and December 2011 were collected. All patients were treated with T-shaped field （including bilateral supraclavicular region, upper-middle mediastinal region and anastomosis site） adjuvant postoperative radiotherapy. The radiation dose was 50 Gy in 25 fractions. Results： All patients completed and tolerated radiation therapy well. Fifteen patients （17%, 15/88） developed recurrence and metastasis. A simple in-field recurrence was seen in two patients, celiac lymph node recurrence in two patients, concurrence of in-field recurrence and distant metastasis in 2 patients, and distant metastasis in 9 patients. The one-, two- and three-year disease-free survival rates were 93.2%, 80.8% and 56.0%, respectively. The one-, two- and three-year overall survival rates were 98.9%, 84.4% and 58.8%, respectively. The main adverse effects were radiation pneumonitis, radiation esophagitis, esophageal fibrosis and radiation dermatitis. Grade Ⅳ adverse reactions were not observed. Conclusion： The local-regional recurrence rate is relatively lower in esophageal carcinoma patients treated with T-shaped field adjuvant postoperative radiotherapy after radical left thoracotomy resection. The adverse effects are acceptable, but the distant metastasis rate is still high.