食管癌切除术后纵隔及双锁骨上下区照射的远期生存

Long-term Survival of the Patients with Esophageal Cancer after Resection Plus Postoperation Radiation on Mediastinal and Superclavical Region

目的：探讨食管鳞癌（EC ）切除后纵隔及双锁骨上下区预防性或补充性放疗的意义及放疗对生存率、局部复发率和远处转移率的影响。方法：对１ ８５ 例EC 术后患者加与不加纵隔及双锁骨上下区放射治疗进行随机分组观察。结果：所有病例均获随访。两组总生存率及转移率差异无显著性意义（P＞０ ．０ ５）。总复发率亦无显著性差异（P＞０．０５），但姑息手术后放疗组的复发率低于单一手术组（P＜０ ．０ ５）。结论：EC 切除术后纵隔及双锁骨上下区放射治疗能有效控制局部癌组织残留者的复发，但对较早期病变无预防作用。因此，EC 术后放疗仅适用于手术中有明显癌组织残留或残留可能性大者。

Objective: To evaluate the significance of the adjuvant radiotherapy following esophagectomy, especially focusing on the survival, local recurrence and metastasis. Methods: 185 patients with esophageal squamous cell carcinoma were randomized into surgery plus radiation group(S+R: 92 cases) and sole surgery group (SS: 93 cases) in this prospective study. The dose of radiation was 50~60Gy. Results: There were no differences in overall survival rate, recurrence and metastasis (P>0.05). The rate of complication in S+R group was higher than that in SS group (P<0.05). Compared with surgery only, the recurrent rate in palliative resection group with radiation was lower (P<0.05). Conclusion: Radiation on mediastinum and bilateral superclavical region can effectively control the local recurrence for patient with residual tumor but has not preventive effect for patients with radical resection.