食管癌根治性放疗后局部复发再程三维适形放疗临床分析

Analysis of three-dimensional conformal radiotherapy for local recurrence of esophageal cancer after definitive radiotherapy

目的 研究食管癌根治性放疗后局部复发行再程三维适形放疗（3DCRT）的安全性、疗效及影响生存预后因素.方法 回顾性分析2010年1月至2014年4月本院收治的46例食管癌根治性放疗后局部复发行3DCRT再程治疗患者的治疗效果,并应用Log-rank进行单因素预后分析,用Cox比例风险模型进行预后的多因素分析.结果 6例患者未完成放疗,40例患者顺利完成放疗,3DCRT总有效率为80.0％ （32/40）.1、2年生存率分别为47.5％ （19/40）、20.0％ （8/40）.再程放疗中出现2＋3级的放射性消化道反应19例（47.5％）、放射性肺炎14例（35.0％）、造血系统毒性反应6例（15.0％）、心脏毒性4例（10.0％）,全组均未出现4度以上放射性损伤及治疗相关性死亡.单因素分析显示年龄（x2=8.432,P=0.015）、放疗间隔时间（x2=7.006,P=0.008）、放疗剂量（x2=18.718,P=0.000）、大体肿瘤体积（GTV） （x2=10.121,P=0.006）、辅助化疗（x2=5.014,P=0.025）、肿瘤长度（x2=7.391,P=0.025）、野内复发（x2 =9.933,P=0.002）、肿瘤控制情况（x2=14.665,P=0.001）与预后密切相关;病变部位有影响总生存的趋势（x2=5.493,P=0.064）;多因素分析显示年龄（x22=4.759,P=0.029）、放疗间隔时间（x2 =4.139,P=0.041）、GTV （x2=4.799,P=0.024）、肿瘤控制情况（x2=4.501,P=0.030）是影响总生存时间的重要因素.结论 对于食管癌根治性放疗后局部复发患者,3DCRT再程放疗虽然毒性反应大,但其可提高近期疗效.年龄、放疗间隔时间、GTV、肿瘤控制情况是再程放疗的预后因素.

Objective To evaluate the safety,clinical effect and prognosis of three-dimensional conformal radiotherapy （3DCRT） for local recurrent esophageal cancer after definitive radiotherapy.Methods From January 2010 to April 2014,the treatment effects of 46 patients received 3DCRT with local recurrent esophageal cancer after definitive radiotherapy in our hospital were analyzed retrospectively.The Log-rank test was used for univariate prognostic analysis,and the Cox regression model was used for multivariate prognostic analysis.Results Forty patients achieved radiotherapy,6 patients did not finish radiotherapy.The total effective rate of 3DCRT was 80.0% （32/40）.The overall 1-and 2-year survival rates were 47.5% （19/40） and 20.0% （8/40）.During the radiation therapy,the incidence rates of grade 2 ＋ 3 acute radiation-induced esophageal toxicity,radiation pneumonitis,hematopoietic toxicity reaction and cardiac toxicity were 47.5% （19 cases）,35.0% （14 cases）,15.0% （6 cases） and 10.0% （4 cases） respectively.There was no treatment-related death and no patients experienced any grade 4 toxicities.Univariate analysis results showed the age （x2 =8.432,P =0.015）,interval time of radiotherapy （x2 =7.006,P =0.008）,radiation dose （x2 =18.718,P =0.000）,gross tumor volume （GTV） （x2 =10.121,P =0.006）,adjuvant chemotherapy （x2 =5.014,P =0.025）,tumor length （x2 =7.391,P =0.025）,in-field failure （x2 =9.933,P =0.002）,tumor control （x2 =14.665,P =0.001） were closely related with prognosis.Diseased region had a tendency to affect overall survival （x2 =5.493,P =0.064）.Multivariate analysis results showed that age （x2 =4.759,P =0.029）,interval time of radiotherapy （x2 =4.139,P =0.041）,GTV （x2 =4.799,P =0.024）,tumor control （x2 =4.501,P =0.030） were independent prognostic factors for overall survival.Conclusion To patients with local recurrent esophageal cancer after definitive radiotherapy,despite acute toxicity rate is high.3DCRT is an alternative effective method,which can improve the short-term efficacy.The age,interval time of radiotherapy,GTV and tumor control are prognosis factors.