老年局部晚期食管癌患者调强放疗效果及预后分析

Efficacy and prognosis analysis of intensity-modulated radiotherapy in elderly patients with locally advanced esophageal cancer

目的探讨老年局部晚期食管癌患者调强放疗(IMRT)的效果及预后影响因素。方法回顾分析2005年1月至2015年12月苏州大学附属常州肿瘤医院87例接受IMRT及79例接受三维适形放疗(3DCRT)的老年局部晚期食管癌患者的临床资料,观察其疗效及不良反应,并用log-rank检验及Cox比例风险模型对接受IMRT患者的预后影响因素进行单因素及多因素分析。结果IMRT组完全缓解27例(31.0%),部分缓解60例(69.0%);3DCRT组完全缓解18例(22.8%),部分缓解61例(77.2%);两组近期疗效(CR+PR)差异无统计学意义(χ^(2)=1.43,P=0.232)。IMRT组1、3、5年总生存率分别为77.0%、46.0%、23.0%,3DCRT组分别为70.1%、40.5%、10.1%,两组总生存差异有统计学意义(χ^(2)=4.89,P=0.027)。对于接受IMRT的老年局部晚期食管癌患者,单因素分析结果显示,性别、病变部位、T分期、肿瘤靶区体积、近期疗效均为预后影响因素(均P<0.05);多因素分析结果显示,病变部位、T分期、肿瘤靶区体积、近期疗效均是预后的独立影响因素(均P<0.05)。IMRT组≥2级放射性肺炎发生率为10.3%(9/87),≥2级放射性食管炎发生率为32.2%(28/87),白细胞降低发生率为18.4%(16/87),血红蛋白降低发生率为7.0%(6/87);IMRT组与3DCRT组急性不良反应发生率比较,差异均无统计学意义(均P>0.05)。结论IMRT治疗老年局部晚期食管癌患者比3DCRT更具优势,尤其是颈胸上段、T1~3期、肿瘤靶区体积≤40 cm3、近期疗效为完全缓解者更能从中获益,且不良反应较轻。

Objective To explore the efficacy and prognostic factors of intensity-modulated radiotherapy(IMRT)in elderly patients with locally advanced esophageal cancer.Methods The clinical data of 87 elderly patients with locally advanced esophageal cancer who received IMRT and 79 elderly patients with locally advanced esophageal cancer who received three-dimensional conformal radiotherapy(3DCRT)from January 2005 to December 2015 in Changzhou Cancer Hospital Affiliated to Soochow University were retrospectively analyzed,and their efficacy and adverse reactions were observed.The log-rank test and Cox proportional hazards model were used for univariate and multivariate analyses to analyze the prognostic factors of patients receiving IMRT.Results In the IMRT group,27 cases(31.0%)achieved complete remission,and 60 cases(69.0%)achieved partial remission;in the 3DCRT group,18 cases(22.8%)achieved complete remission,and 61 cases(77.2%)achieved partial remission.There was no statistical difference in the short-term efficacy(CR+PR)between the two groups(χ^(2)=1.43,P=0.232).The 1-,3-,and 5-year overall survival rates in the IMRT group were 77.0%,46.0%and 23.0%,respectively,and the 3DCRT group were 70.1%,40.5%and 10.1%,respectively.There was a statistical difference in the overall survival between the two groups(χ^(2)=4.89,P=0.027).For elderly patients with locally advanced esophageal cancer who received IMRT,univariate analysis showed that gender,lesion location,T stage,gross tumor volume,and short-term efficacy were prognostic factors(all P<0.05);multivariate analysis showed that lesion location,T stage,gross tumor volume,and short-term efficacy were independent prognostic factors(all P<0.05).In the IMRT group,the incidence rate of≥grade 2 radiation pneumonitis was 10.3%(9/87),the incidence rate of≥grade 2 radiation esophagitis was 32.2%(28/87),the incidence rate of leukopenia was 18.4%(16/87),and the incidence rate of hemoglobin reduction was 7.0%(6/87),and there was no statistical difference in the incidence of acute adverse reactions between the IMRT group and the 3DCRT group(all P>0.05).Conclusions IMRT has more advantages than 3DCRT in the treatment of elderly patients with locally advanced esophageal cancer,especially those with upper cervical and thoracic lesion,T1-3 stage,gross tumor volume≤40 cm3,and complete remission in a short term can benefit from it,and the adverse reactions are mild.