挽救性放疗在术后区域淋巴结寡复发食管癌再程治疗的作用

The role of salvage radiotherapy in re-treatment of esophageal squamous cell carcinoma with regional lymph node oligo-recurrence after surgery

目的分析挽救性放疗在食管鳞癌根治性手术后发生区域淋巴结寡复发患者再程治疗中的作用。方法回顾分析2013-2016年间确诊的胸段食管鳞癌,首程治疗接受根治性手术且根治术后发生局部区域淋巴结寡复发(1~3个),病例资料完整可分析者共74例。采用Kaplan-Meier法生存分析,Logrank法行组间对比。结果复发后全组中位总生存(OS)期9个月(2.5~43个月),复发后中位无进展生存(PFS)期4个月(1~33个月)。挽救性放疗、未放疗分别为47、27例,治疗客观缓解率分别为77%(36/47)和30%(8/27)。挽救性放疗组比未放疗组有更好的OS(P=0.042)和PFS(P=0.01)。挽救性放疗患者中累及野放疗和选择野放疗有着相似的OS(P=0.963)和PFS(P=0.599);放疗剂量≥60Gy比<60Gy有着更好的OS(P=0.001)和PFS(P=0.001)。结论对于局部区域淋巴结寡复发的食管鳞癌术后患者,局部挽救性放疗比未放疗有更好的OS和PFS。建议开展前瞻性临床研究进一步明确放疗的作用并规范放疗靶区和剂量。

Objective To evaluate the role of salvage radiotherapy in the re-treatment of patients with regional lymph node oligo-recurrence after radical surgery for esophageal squamous cell carcinoma.Methods Clinical data of patients diagnosed with thoracic esophageal squamous cell carcinoma treated with radical surgery and developed regional lymph node oligo-recurrence(n=1-3)from January 2013 to January 2016 were retrospectively analyzed.A total of 74 cases with intact clinical data were extracted for analysis.The survival analysis was performed by Kaplan-Meier method.Group comparison was conducted by Log-rank method.Results The median overall survival(OS)after recurrence was 9(2.5-43)months,and the median progression-free survival time(PFS)was 4(1-33)months.There were 47 cases in the salvage radiotherapy group and 27 cases in the non-radiotherapy group,and the objective response rates were 77%(36/47)and 30%(8/27),respectively.Patients in the salvage radiotherapy group had better OS(P=0.042)and PFS(P=0.01)compared with their counterparts in the non-radiotherapy group.Among the patients who received salvage radiotherapy,involved field irradiation and elective nodal irradiation yielded similar OS(P=0.963)and PFS(P=0.599),and patients treated an irradiation dose≥60Gy had better OS(P=0.001)and PFS(P=0.001)compared with those with dose<60Gy.Conclusions Local salvage radiotherapy is an effective treatment of esophageal squamous cell carcinoma with regional lymph node oligo-recurrence after radical surgery.Salvage radiotherapy has better OS and PFS compared with non-radiotherapy.Prospective clinical studies should be carried out to standardize the target and dose of radiotherapy,and to further clarify the effect of radiotherapy.