放疗剂量对颈段食管癌疗效的影响及预后因素分析

Effects of radiotherapy dose on cervical esophageal carcinoma and related prognosic factors analysis

目的:观察放疗剂量对颈段食管癌(cervical esophageal carcinoma,CEC)疗效的影响,并对CEC的预后因素进行分析。方法:回顾性分析2013—2018年收治的96例接受三维适形放疗或调强放疗的CEC患者,依据大体肿瘤放疗剂量分为低剂量组(≤60 Gy)、中剂量组(>60~<66 Gy)及高剂量组(≥66 Gy),比较各组临床疗效、急性不良反应及治疗失败模式的差异,并分析CEC患者的相关预后因素。结果:放疗结束后1个月观察近期疗效,3组的有效率分别为66.7%、85.4%、85.7%,差异无统计学意义(P=0.114);单因素分析显示放疗剂量是总生存(overall survival,OS)(P=0.031)、无进展生存(progression-free survival,PFS)(P=0.045)、无局部区域进展生存(local-regional failure-free survival,LRFFS)(P=0.020)的影响因素,中、高剂量组疗效无差异,且均较低剂量组好(P<0.05)。CEC OS的独立预后因素是放疗剂量、是否同步化疗及邻近器官是否受侵。结论:CEC采用根治性放化疗可获得较好疗效,中剂量即>60~<66 Gy可能是CEC更为合理的放疗剂量;放疗剂量、是否同步化疗及邻近器官是否受侵是CEC OS的独立预后因素。

Objective:To observe the effect of radiotherapy dose on cervical esophageall carcinoma,and to analyze the prognostic factors of cervical esophageal carcinoma.Methods:A retrospective analysis was performed on 96 patients with cervical esophageal carcinoma who received three dimensional conformal radiation therapy or intensity-modulated radiation therapy from 2013 to 2018 according to inclusion criteria.All the patients are divided into three groups according to the radiation dose of gross tumor:the low-dose group(≤60 Gy),the medium-dose group(>60~<66 Gy)and the high-dose group(≥66 Gy)respectively.The clinical effect,acute adverse effects,and treatment failure mode were compared among three groups,and the prognostic factors of cervical esophageal carcinoma were analyzed.Results:The short-term efficacy was observed one month after radiotherapy,and the objective response rate was 66.7%,85.4%,and 85.7%,respectively.There was no statistical difference among three groups(P=0.114).The univariate analysis showed that radiotherapy dose was the influencing factor of overall survival(P=0.031),progression-free survival(P=0.045)and localregional failure-free survival(P=0.020),and there was no difference in the efficacy between the middle-dose group and the high-dose group,and all of them better than the low-dose group(P<0.05).The independent prognostic factors of OS for cervical esophageal carcinoma are radiotherapy dose,synchronous chemotherapy,and invasion of adjacent organs.Conclusion:Radical chemoradiotherapy is effective for cervical esophageal cancer,and the medium dose,i.e.>60~<66 Gy,may be a more reasonable radiotherapy dose for cervical esophageal cancer.Radiotherapy dose,concurrent chemotherapy and invasion of adjacent organs are independent prognostic factors of OS.