放疗对高龄食管癌患者的疗效及预后影响因素研究

Analysis of the Efficacy of Radiotherapy on Esophageal Cancer and Identification of Associated Prognostic Factors in Elderly Patients

目的探讨累及野照射(IFI)和选择性淋巴引流区照射(ENI)对高龄食管癌患者的疗效及预后影响因素。方法选取2011年7月—2013年8月于衢州市人民医院进行单纯三维适形放疗的高龄食管癌患者87例,根据放疗方式的不同将其分为IFI组45例和ENI组42例。IFI组大体肿瘤靶区为食管原发灶和肿大淋巴结,ENI组大体肿瘤靶区为食管原发灶及本段食管的淋巴结引流区。两组照射剂量50~60 Gy/次,5~6次/周,共5~6周。对患者进行电话随访,截至2016年12月。观察两组治疗1年、2年、3年总生存率(OS);并观察两组毒副作用发生情况;分析影响患者预后的因素。结果两组1年、2年、3年OS比较,差异均无统计学意义(P>0.05)。两组患者放射性肺炎发生情况比较,差异无统计学意义(P>0.05);IFI组放射性食管炎发生情况优于ENI组,差异有统计学意义(P<0.05)。不同癌变部位、Karnofsky功能状态评分(KPS评分)、放疗方法患者3年OS比较,差异均无统计学意义(P>0.05);不同性别、年龄、T分期、N分期患者3年OS比较,差异均有统计学意义(P<0.05)。多因素Cox回归分析结果显示,年龄[RR=2.334,95%CI(1.144,4.759)]、T分期[RR=0.361,95%CI(0.179,0.729)]为高龄食管癌患者预后的独立影响因素(P<0.05)。结论 IFI与ENI放疗效果相当,但IFI在减轻放射性食管炎严重程度上更具有优势,同时年龄、T分期为高龄食管癌患者预后的独立影响因素。

Objective To investigate the efficacy of involved field irradiation(IFI)and elective nodal irradiation(ENI)in treating elderly esophageal cancer patients and identification of associated prognostic factors.Methods A total of 87 elderly esophageal cancer patients who underwent three dimensional(3D)conformal radiation therapy at the Quzhou People's Hospital between July 2011 and August 2013 were enrolled in this study.The patients were divided into IFI(n=45)and ENI groups(n=42).Within the IFI group,the gross tumor volume(GTV)included primary esophageal tumors and enlarged lymph nodes,while within the ENI group,the GTV included primary esophageal tumors and lymphatic drainage area of the corresponding esophageal segments.The radiation dosage in both groups was 50-60 Gy/time,5-6 times/week,and continued for 5-6 weeks.The patients were followed by telephone until December 2016.The 1-,2-,and 3-year overall survival(OS)rate,as well as adverse reactions in the two groups,were compared.The potential factors influencing patient prognosis were also analyzed.Results There were no significant differences in the 1-,2-,and 3-year OS between the two groups(P>0.05).The incidence of radiation pneumonitis in both groups was not significantly different(P>0.05).The incidence of radiation esophagitis in the IFI group was lower than the ENI group(P<0.05).Tumor site,KPS score,and radiotherapy approach did not significantly affect the 3-year OS(P>0.05),while the 3-year OS differed significantly among patients as a function of gender,age,T stage,and N stage(P<0.05).Multivariate Cox regression analysis suggested that age〔RR=2.334,95%CI(1.144,4.759)〕and T stage〔RR=0.361,95%CI(0.179,0.729)〕were independent prognostic factors for elderly patients with esophageal cancer(P<0.05).Conclusion IFI and ENI were shown to have comparable efficacy;however,IFI has the advantage of reducing the severity of radiation esophagitis compared with ENI.Age and T stage were shown to be independent prognostic factors for elderly patients with esophageal cancer.