食管癌根治术后放射治疗的价值

Postoperative radiotherapy after radical resection for esophageal carcinoma.

目的 评价食管癌根治术后放射治疗的价值。方法 收治 2 6 5例食管癌根治术后放射治疗病人 ,均为鳞癌。 72 8% (193例 )的病人始于术后 8周以内。照射野包括双锁骨上区、纵隔、吻合口及胃左动脉淋巴结区。放疗剂量 4 5～ 5 5Gy。 94 %的病人放疗剂量为 5 0Gy ,放疗采用常规分割照射。结果 2 6 5例病人总的 1、2、3、4、5年生存率为 81 5 %、6 3 0 %、5 0 9%、4 6 1%、39 5 %。肿瘤外侵阳性病人预后较外侵阴性病人差 (P <0 0 1) ,但肿瘤外侵阳性病人 5年生存率仍达 35 3%。淋巴结阳性病人预后极差 ,5年生存率仅 9% ,与淋巴结阴性的病人相比有显著差异 (P <0 0 0 5 )。本组死亡 139例 ,其中血行转移 5 2例(肺转移 18例、肝转移 14例、骨转移 8例、其它 12例 )占 37 4 % ,纵隔食管瘤床复发 +纵隔淋巴结转移 2 9例占 2 0 9% ,腹腔淋巴结转移 16例占 11 5 %。结论 ①除淋巴结阳性病人外 ,食管癌根治术后预防性照射可降低局部区域复发 ,提高远期生存。②对淋巴结阳性病人 ,术后放疗疗效差。③无论肿瘤外侵情况如何 ,食管癌术后放射治疗均有价值 ,但肿瘤外侵阳性病人预后相对较差。④放疗区域应包括肿瘤瘤床和淋巴引流区。⑤术后放疗剂量Dt5 0Gy是合适的。

Objective To evaluate the role of postoperative radiotherapy after radical resection for esophageal cacinoma. Methods From 1987 1997,265 patients with squamous carcinoma were treated by radical operation combined with postoperative irradiation. The irradiation target volume was tumor beds and regional lymphatics areas. The radiation dose was 45～55Gy. Results The overall 1?2?3?4?5-year survival rates were 81 5%?63 0%?50 9%?46 1%?39 5%.The survival rates for patients with positive extraesophageal extension were poorer than those patients without extraesophageal extension. The difference was statistically significant( P <0 01). The 5-year survival rate for patients with positive extraesophageal extension was 35 3%,Which was still better than patients with operation alone. The patients with positive lymph node metastases had very poor prognosis. The 5-year survival rate was only 9%,Which was significantly poorer than that of patients with negative lymph node metastases ( P <0 005). The main causes of death were distant metastases(37 4%,52 cases), local and regional relapes (20 9%,29cases)and lymph node metastases in abdomen (11 5%,16 cases).Conclusion ① The postoperative radiation therapy can increase survival rate after radical resection for esophageal cancer patients with negative lymph node metastases. ②The patients with positive lymph node metastases treated with postoperative radiation therapy had poor prognosis.③The postoperative radiation therapy shows effects for patients either with positive extraesophageal extension or without, but the prognosis for patients with positive extraesophageal extension is a little poorer than that of patients without extraesophageal extension.