选择性区域淋巴结照射对临床早期食管癌放疗疗效的影响

Analysis on efficacy of different radiotherapy methods in no-metastasis esophageal squamous cell carcinoma

目的 评价临床无转移且病变长度≤5.0 cm的食管鳞癌（ESCC）接受不同放疗方式治疗的疗效.方法 对符合入组条件的158例临床无转移且病变长度≤5.0 cm的ESCC患者进行回顾性分析,分析不同治疗方式对此部分患者的治疗疗效、预后因素及不良反应等的影响.结果 选择性淋巴结照射（ENI）与累及野照射（IFI）组患者近期疗效差异无统计学意义.与IFI患者相比,ENI患者的总生存率（OS）及肿瘤特异性生存率（TSS）提高（χ^2=11.21、8.57,P＜0.05）,而局部复发率（LR）及远处转移率（DM）降低（χ^2=4.99、7.48,P＜0.05）.多因素分析结果显示,ECOG分级和近期疗效为IFI组患者的独立性预后影响因素（χ^2=15.05、10.32,P＜0.05）,CT显示食管病变最大直径为ENI组患者的独立性预后影响因素（χ^2=8.32,P＜0.05）.ENI与IFI患者出现≥2级急性放射性食管炎（RE）及放射性肺炎（RP）的差异均无统计学意义.结论 放化疗对于临床无转移且病变长度≤5.0 cm的ESCC患者有较好疗效,ENI较IFI更可能给患者的生存带来益处.

Objective To evaluate the curative effect of different radiotherapy methods in nometastasis and lesion length ≤ 5.0 cm esophageal squamous cell carcinoma （ESCC）.Mothods A total of 158 eligible patients were retrospectively analyzed.The treatment out comes prognosis factors,and toxicity were evaluated.Results There were no significantly differences in curative effect for ENI and IFI group（x2 =2.17,P 〉 0.05）.Compared with IFI group,the OS and TSS were significantly higher than in ENI group （χ^=11.21,8.57,P 〈 0.05）,and the LR ratio and DM ratio were significantly lower than that of the IFI patients （χ^ =4.99,7.48,P 〈 0.05）.Multivariate analysis showed that ECOG grade and short-term effect （χ^ =15.05,10.32,P 〈 0.05） were the independent prognostic factor for IFI,while the maximum diameter of CT（χ^ =8.32,P 〈 0.05） was the independent prognostic factor for ENI.There were no significant differences in acute radiation esophagitis and pneumonitis between ENI and IFI groups.Conclusions Radiotherapy in combination with chemotherapy has a good curative effect in no-metastasis and lesion length ≤ 5.0 cm ESCC patients.More survival benefit might be achieved by ENI than IFI.