摘要
目的:评价螺旋断层放疗同步化疗对胸段食管鳞癌伴淋巴结跳跃性转移的疗效。方法:入选86例首诊发现淋巴结跳跃性转移的胸段食管癌患者,均行螺旋断层放射治疗,每周5次。食管肿瘤原发灶治疗剂量50.0~56.0Gy,颈部淋巴结转移灶放疗剂量55.0~61.6Gy,胸部淋巴结转移灶放疗剂量50.0~56.0Gy,腹部淋巴结转移灶放疗剂量50.0~54.0Gy;全食管局部淋巴引流区预防性照射剂量45.0~50.4Gy。患者同步行紫杉醇+卡铂化疗。采用Kaplan-Meier法计算患者的生存率,用Cox回归模型分析患者的生存影响因素。结果:患者中位生存期(496±233)d。86例患者中,19例存活、56例死于食管癌原发病和淋巴结转移、6例死于治疗相关性疾病、5例死于非肿瘤性疾病。放化疗不良反应主要为Ⅰ度和Ⅱ度,其中中性粒细胞下降46例(52.3%)、急性放射性食管炎40例(46.5%)、急性放射性肺炎8例(7.4%);另有5例(5.8%)患者发生Ⅳ度食管放射性损伤。Cox模型显示,T分期和淋巴转移数目是影响患者生存的主要因素(P<0.05)。结论:螺旋断层放疗同步化疗能延长胸段食管癌淋巴结跳跃性转移的患者的生存时间,患者能耐受放化疗不良反应。
Objective:To evaluate the efficacy of helical tomotherapy combined with chemotherapy in the treatment of thoracic esophageal squamous carcinoma with lymph node skip metastasis.Methods:A total of86cases of thoracic esophageal carcinoma with lymph node skip metastasis were retrospectively enrolled.Helical tomotherapy was used for all patients at5fractions per week.The most commonly prescribed dose were a total dose of50.0-56.0Gy for primary esophageal tumor,55.0-61.6Gy for the cervical lymph node metastasis,50.0-56.0Gy for the thoracic lymph node metastasis,50.0-54.0Gy for the abdomen lymph node metastasis,and45.0-50.4Gy for the expansively prophylactic esophageal whole regional lymph node.Paclitaxel and cisplatin were concurrently administered.The survival rate was calculated using the Kaplan-Meier method,and the prognostic analysis was assessed by the Cox-regression model.Results:The median survival time was496±233days for all patients with the node skip metastases.Of the86patients,19patients were still alive as of the last follow-up,56patients died of the primary esophageal cancer and lymph node metastasis,6patients died of the treatment-related diseases,and5patients died of non-neoplastic diseases.And the most frequent observed toxicity adverse reactions were GradeⅠorⅡ.Leucopenia was detected in46patients(52.3%),radiation-induced pneumonitis in8cases(7.4%),and esophagitis in40cases(7.4%);GradeⅣradiation-induced esophageal toxicity was detected in5cases(5.8%).Cox model showed that T stage and the number of metastatic lymph node were the main factors affecting the survival of patients(P<0.05).Conclusions:Helical tomotherapy combined with chemotherapy could prolong the survival time of esophageal carcinoma patients who had lymph node skip metastasis,and the adverse reactions of radiotherapy and chemotherapy can be tolerated.
作者
张树民
曾昭冲
朱文超
胡永
ZHANG Shu-min;ZENG Zhao-chong;ZHU Wen-chao;HU Yong(Department of Radiotherapy, Zhongshan Hospital, Fudan University, Shanghai 200032)
出处
《中国临床医学》
2018年第6期940-944,共5页
Chinese Journal of Clinical Medicine
关键词
胸段食管癌
淋巴结跳跃性转移
全食管淋巴引流区
螺旋断层放射治疗
thoracic esophageal carcinoma
lymph node skip metastasis
esophageal whole regional lymph node
helical tomotherapy