三维适形放疗辅助治疗晚期食管癌的近远期预后

Short-term and Long-term Prognosis of Advanced Esophageal Cancer Adjuvantly Treated with Three-dimensional Conformal Radiotherapy

目的探究三维适形放疗(three-dimensional conformal radiotherapy,3D-CRT)辅助治疗晚期食管癌的近远期预后影响。方法选取78例晚期食管癌患者为研究对象,采用随机数字表法分为观察组与对照组,各39例。对照组予以常规放疗,观察组予以3D-CRT。比较2组患者治疗前、治疗2个月后肿瘤情况(CT肿瘤最大横径、CT肿瘤长度),记录2组患者治疗后3个月内放疗不良反应发生率及治疗后第1、2年内累计复发率、病死率。结果治疗2个月后,2组患者CT肿瘤最大横径[观察组:(2.77±1.01)cm,对照组:(3.14±1.19)cm]、CT肿瘤长度[观察组:(5.67±1.08)cm,对照组:(6.14±1.17)cm]均较治疗前下降,且观察组CT肿瘤最大横径小于同期对照组,差异均有统计学意义(P<0.05),2组患者治疗后CT肿瘤长度差异无统计学意义(P>0.05)。治疗后3个月内,2组患者放疗不良反应情况比较,放射性气管炎[观察组:8/39(20.51%),对照组:11/39(28.21%)]、Ⅰ~Ⅱ级放射性食管炎[观察组:11/39(28.21%),对照组:15/39(38.46%)]和骨髓抑制[观察组:25/39(79.49%),对照组:27/39(82.05%)]、放射性肺炎[观察组:11/39(28.21%),对照组:13/39(33.33%)]及恶心呕吐[观察组:4/39(10.26%),对照组:6/39(15.38%)],差异无统计学意义(P>0.05),观察组患者Ⅲ~Ⅳ级放射性食管炎发生率低于对照组[观察组:4/39(10.26%),对照组:12/39(30.77%)]和Ⅲ~Ⅳ级骨髓抑制[观察组:6/39(15.38%),对照组:15/39(38.46%)],差异有统计学意义(P<0.05)。治疗后第1、2年内,观察组患者累计复发率[第1年:2/39(5.13%),第2年:7/39(17.95%)]、病死率[第1年:2/39(5.13%),第2年:6/39(15.38%)]均低于对照组,差异有统计学意义(P<0.05)。结论3D-CRT辅助治疗晚期食管癌近远期预后优于常规放疗,且不良反应相对较少。

Objective To investigate the effects of three-dimensional conformal radiotherapy(3D-CRT)on the short-term and long-term prognosis of advanced esophageal cancer.Methods A total of 78 patients with advanced esophageal cancer were selected as the research objects and randomly divided into the observation group and the control group,with 39 cases in each group.The control group was treated with conventional radiotherapy and the observation group with 3D-CRT.The tumor status(CT tumor maximum diameter,CT tumor length)before and 2 months after the treatment between the two groups were compared.The adverse reaction rate of radiotherapy within 3 months after the treatment and the cumulative recurrence rate and mortality in the first and second years after the treatment were recorded.Results After 2 months of the treatment,the maximum transverse diameter of CT tumors in the observation group and the control group[(2.77±1.01)cm,(3.14±1.19)cm]and CT tumor length[(5.67±1.08)cm,(6.14±1.17)cm]were both lower than thoses before the treatment,and the maximum transverse diameter of CT tumors in the observation group was less than that in the control group during the same period,and the differences were all statistically significant(P<0.05).There was no statistically significant difference in CT tumor length between the two groups after the treatment(P>0.05).Within 3 months after the treatment,there were no statistically significant differences in the adverse reactions of radiation therapy,such as radiation tracheitis in the observation group and the control group[8/39(20.51%),11/39(28.21%)],LevelⅠ-Ⅱradiation esophagitis[11/39(28.21%),15/39(38.46%)],bone marrow suppression[25/39(79.49%),27/39(82.05%)],radiation pneumonia[11/39(28.21%),13/39(33.33%)]and nausea and vomiting[4/39(10.26%),6/39(15.38%)](P>0.05).The incidence of GradeⅢ-Ⅳradiation esophagitis and bone marrow suppression[4/39(10.26%),6/39(15.38%)]in the observation group were respectively lower than those in the control group[12/39(30.77%),15/39(38.46%)],and the differences were statistically significant(P<0.05).In the first and second years after the treatment,the cumulative recurrence rate[2/39(5.13%),7/39(17.95%)]and mortality[2/39(5.13%),6/39(15.38%)]in the observation group were both lower than those in the control group,and the differences were statistically significant(P<0.05).Conclusion The 3D-CRT is superior to the conventional radiotherapy in the short-term and long-term prognosis of advanced esophageal cancer,and the adverse reactions are relatively few.