不同挽救治疗方式对根治性放疗后局部复发食管鳞癌患者的生存影响

Analysis of differential salvage treatments on the survival of local recurrent esophageal squamous cell carcinoma after definitive radiotherapy

目的比较食管鳞癌根治性放疗后局部复发患者接受不同挽救治疗方式的生存结果。方法收集2012年6月—2016年10月在我院住院治疗并符合入组条件的局部复发食管鳞癌患者共124例,根据患者接受挽救治疗方式的不同,将患者分入挽救性手术组63例和挽救性放疗组61例,分析患者接受不同挽救性治疗后的局部控制率、长期生存率和不良反应。结果挽救性手术组与挽救性放疗组患者1、3、5年生存率分别是57.1%,23.8%,9.5%和52.5%,14.8%,4.9%,差异无统计学意义(P>0.05),1、3、5年局部控制率分别是46.0%、15.9%、4.8%和23.0%、8.2%、1.6%,接受挽救性手术的患者有更好的局部控制率(P<0.05)。COX回归分析显示复发间隔时间(RFS≦24月,RFS>24月)是独立的预后因素。两组患者常见的不良反应均是消化道反应和血液学毒性,多为1~2级,挽救性放疗组的治疗相关严重毒性发生率比挽救性手术组低。结论挽救放疗可为根治性放疗后局部复发食管鳞癌患者带来与挽救性手术相似的长期生存,治疗相关严重毒性发生率比挽救性手术低。

Objective To compare the survival outcomes of different salvage treatments for local recurrence esophageal squamous cell carcinoma after definitive radiotherapy.Methods From June 2012 to October 2016,124 eligible esophageal squamous cell carcinoma patients were enrolled for the study.The patients were divided into salvage radiotherapy group(SR group comprised of 61 patients)that received salvage radiotherapy and salvage surgery group(SS group comprised of 63 patients)that received salvage surgery.Results The 1-,3-,and 5-year survival rates of patients in the SS group and the SR group were 57.1%,23.8%,9.5%and 52.5%,14.8%and 4.9%,respectively.The difference was not significant(P>0.05).The 1-,3-,and 5-year local control rates were 46.0%,15.9%,4.8%and 23.0%,8.2%and 1.6%,respectively.Patients receiving salvage surgery had better local control rates(P<0.05).Cox regression analysis showed that recurrence interval(RFS≤24 months,RFS>24 months)was an independent prognostic factor.The common complications in both groups were gastrointestinal reaction and hematological toxicity,mostly grade 1-2.The incidence of death-related toxicity in the SR group was lower than that in the SS group.Conclusion The survival benefit of salvage radiotherapy is similar to salvage surgery.Given the high death-related toxicity after salvage surgery,salvage radiotherapy may be a better choice for patients with a high probability of developing serious treatment-related toxicity.