同步整合加量调强联合选择性淋巴结照射根治性治疗食管鳞癌的长期预后分析

Long-term prognostic analysis of simultaneous integration and intensity modulation combined with selective lymph node radiation radical therapy for esophageal squamous cell carcinoma

目的探讨同步整合加量调强(SIB-IMRT)联合选择性淋巴结照射(ENI)加或不加化疗根治性治疗食管鳞癌患者的长期预后。方法对130例接受根治性放(化)疗的食管鳞癌患者进行回顾性分析,分析患者的长期生存情况及其预后影响因素、治疗失败模式和不良反应情况。结果所有患者1、3、5年总生存(OS)率和无进展生存(PFS)率分别为81.5%、52.7%、39.8%和70.7%、40.6%、35.8%,中位OS期和PFS期分别为36.37个月和23.89个月。多因素Cox分析显示,c T3期、cN1期、未接受化疗和GTV-V>37.0 cm3为影响患者OS的独立危险因素,c T3期为影响患者PFS的独立危险因素(P<0.05)。所有患者出现局部区域复发39例(30.0%),远隔部位转移20例(15.4%),其中两者并存4例;单纯局部区域复发的35例患者中原食管病变局部复发32例,区域淋巴结复发1例,食管局部联合区域淋巴结复发2例。所有患者治疗期间及治疗后未出现≥4级相关不良反应。化疗组患者的≥2级不良反应发生率与未化疗组患者差异无统计学意义。结论 SIB-IMRT联合ENI治疗食管鳞癌患者安全有效,对一般情况较好的患者可予以联合化疗。

Objective To investigate the long-term prognosis of simultaneous integrated intensity modulation(SIBIMRT) combined with selective lymph node irradiation(ENI) with or without chemotherapy for radical treatment of esophageal squamous cell carcinoma.Methods Data of 130 patients with esophageal squamous cell carcinoma who received radical radiotherapy were analyzed retrospectively,and the long-term survival,prognostic factors,treatment failure mode and adverse reactions were analyzed.Results The 1-,3-and 5-year overall survival(OS) and progression-free survival(PFS) rates were 81.5%,52.7%,39.8% and 70,7%,40.6%,35.8%,respectively.The median OS stage and PFS stage were 36.37 months and 23.89 months,respectively.Multivariate Cox analysis showed that cT_(3),cN_(1),no chemotherapy and GTV-V>37.0 cm^(3) were independent risk factors for OS,and cT_(3) was independent risk factors for PFS(P<0.05).In all patients,39 patients(30.0%) had local recurrence,20 patients(15.4%) had distant metastasis,and 4 patients had both.Among the 35 patients with local regional recurrence,there were 32 cases of local esophageal lesion recurrence,1 case of regional lymph node recurrence,and 2 cases of local esophageal combined regional lymph node recurrence.All patients had no grade≥4 related adverse reactions during and after treatment.There was no significant difference in the incidence of grade≥2 adverse reactions between patients with combined chemotherapy and patients without combined chemotherapy.Conclusion SIB-IMRT combined with ENI is safe and effective in the treatment of patients with esophageal squamous cell carcinoma.It is recommended to combine chemotherapy for patients with better general conditions.