基于调强技术的术前同步放化疗联合手术治疗胸段食管鳞癌的疗效分析

IMRT-based preoperative neoadjuvant chemoradiotherapy for thoracic esophageal squamous cell carcinoma （ESCC）：an analysis of outcome and prognosis

目的：分析利用调强技术行术前同步放化疗联合手术治疗胸段食管鳞癌的疗效和预后影响因素。方法回顾性分析2009年1月至2015年1月于中国医学科学院肿瘤医院行术前同步放化疗联合手术治疗的62例胸段食管鳞癌患者的临床资料，全部患者均采用常规分割的调强放疗（IMRT），并接受根治性食管切除加区域淋巴结清扫。结果62例患者的R0切除率为96．8％，pCR率为32．3％，病理降期率为90．3％。Ⅲ度骨髓抑制的发生率为12．9％，Ⅲ度放射性食管炎的发生率为3．2％。11例（17．7％）患者出现术后并发症，其中3例死亡。62例患者的中位随访时间为27个月，1、3、5年总生存率分别为88．0％、63．3％和44．2％，1、3、5年无病生存率分别为68．1％、54．8％和43．9％。单因素分析显示，治疗前Ⅱ期、降期、肿瘤或淋巴结病理完全缓解（ T／NpCR）、肿瘤反应好、pN0期和R0切除的患者预后较好（均P＜0．05）。多因素分析显示，治疗前分期是影响患者预后的独立因素（ P＜0．05）。结论胸段食管鳞癌术前同步放化疗联合手术可获得较高的R0切除率、降期率和pCR率，且患者耐受性较好，治疗前分期、是否降期、肿瘤病理反应、淋巴结转移情况及R0切除情况与患者的预后有关，其中治疗前分期是独立的预后因素。

Objective To analyze the outcome and prognostic factors of IMRT？based preoperative neoadjuvant chemoradiotherapy in patients with thoracic esophageal squamous cell carcinoma （ ESCC ） . Methods Clinical data of 62 patients with thoracic ESCC who received IMRT？based neoajuvant chemoradiotherapy from January 2009 to January 2015 were retrospectively analyzed. The radiation therapy was given 1.8-2 Gy/fraction per day over 5 days per week with 6 MV X-rays, and then all patients underwent esophagectomy and lymphadenectomy. Results Among the 62 patients, the R0 resection rate was 96.8%. Twenty （ 32. 3%） patients achieved pCR and 56 （ 90. 3%） cases got down-staging. Grade Ⅲ marrow suppression and esophagitis were seen in 8 （12.9%） and 2 （3.2%） patients, respectively. Eleven （17.7%） patients experienced postoperative complications and three died. The median follow-up was 27 months. The 1-, 3-and 5-year overall survival rates were 88.0%, 63.3% and 44.2%, respectively, with a corresponding disease？free survival rate of 68. 1%, 54. 8%, and 43. 9%, respectively. The univariate analysis showed that pre-treatment stage Ⅱ, down-staging, T/N pCR, good tumor response to neoadjuvant chemoradiotherapy, pN0 and R0 resection were favorable prognostic factors （P〈0.05）. The multivariate analyses indicated that pre-treatment stage was an independent prognostic factor. Conclusions For patients with thoracic ESCC, IMRT-based neoadjuvant chemoradiotherapy followed by surgery can achieve a higher R0 resection rate, down-staging rate, higher pCR rate, and a better tolerance. The incidence of postoperative complications is low. Pre-treatment stage, down？staging, pathological tumor response, lymph node status and R0 resection results are prognostic factors, and the pre-treatment stage is an independent prognostic factor.