胃镜下钛夹标记在不可切局部晚期食管癌患者进行根治性调强放疗时靶区勾画的价值研究

The Value of Titanium Clamp Labeling Under Gastroscope in Target Delineation of Radical Intensity Modulated Radiotherapy for Patients with Inoperable Locally Advanced Esophageal Cancer

目的:探讨胃镜下钛夹标记在不可切局部晚期食管癌患者进行根治性调强放疗时靶区勾画的价值。方法:选取2021年1~12月我院收治行根治性调强放疗的不可切局部晚期食管癌患者150例为研究对象,按随机数字表法分为对照一组、对照二组及观察组,每组各50例,比较3组患者靶区勾画效果,评估放疗6周后近期疗效,统计不良反应,随访至2024年6月,分析远期预后,评定记录无进展生存期(FPS)及总生存期(OS)情况。结果:3组患者病灶长度、GTV、CTV比较,差异有统计学意义(P<0.05),观察组、对照二组患者病灶长度、GTV、CTV均高于对照一组患者(P<0.05),观察组与对照二组患者病灶长度、GTV比较,差异无统计学意义(P>0.05),但观察组患者CTV低于对照二组患者(P<0.05);3组患者治疗总有效率比较,差异有统计学意义(P<0.05),且观察组患者总有效率为96.00%,高于对照一组患者的84.00%(P<0.05);3组患者不良反应情况比较,差异无统计学意义(P>0.05);随访截至2024年6月,对照一组患者PFS 1~17个月(9个月)、OS 2~31个月(15个月);对照二组患者PFS 1~16个月(10个月)、OS 2~34个月(15个月);观察组患者PFS 3~20个月(12个月)、OS 3~44个月(22个月),经Kaplan-Meier生存曲线显示,观察组患者PFS、OS长于对照一组和对照二组患者(P<0.05)。结论:胃镜下钛夹标记有助于精准勾画不可切局部晚期食管癌患者靶区,可避免食管钡餐造影定位后放疗剂量不充分以及CT扫描定位后正常器官受照剂量增多的影响,可获可靠近期疗效,且远期预后良好。

Objective:To evaluate the value of titanium clamp labeling under gastroscopy in target delineation of radical intensity modulated radiotherapy(IMRT)in patients with inoperable locally advanced esophageal cancer.Methods:A total of 150 patients with inoperable locally advanced esophageal cancer who received radical intensity modulated radiotherapy in our hospital from January 2021 to December 2021 were selected as the research objects.They were divided into the control group 1,control group 2 and observation group according to random number table method.Esophageal barium meal imaging was performed before radiotherapy in control group 1,and CT scanning was performed in control group 2 before radiotherapy.The observation group was labeled with titanium clamp under gastro‐scope before radiotherapy,and the delineation effect of target areas was compared among the three groups.The short-term efficacy after 6 weeks of radiotherapy was evaluated,adverse reactions were observed,and the long-term prognosis was analyzed by recording progression-free survival(PFS)and overall survival(OS)for evaluation.Results:There were statistically significant differences in lesion length,GTV,and CTV among the three groups of patients(P<0.05).The lesion length,GTV,and CTV of the observation group and the control group 2 were higher than those of the control group 1(P<0.05).There was no statistically significant difference in lesion length and GTV between the observation group and the control group 2(P>0.05),but the CTV of the observation group was lower than that of the control group 2(P<0.05).The total effective rate of the three groups of patients was compared,and the difference was statisti‐cally significant(P<0.05).The total effective rate of the observation group was 96.00%,which was higher than that of the control group 1(84.00%)(P<0.05).There was no statistically significant difference in adverse reactions among the three groups of patients(P>0.05).Follow up until June 2024,the control group 1 patients had PFS of 1-17 months(9 months)and OS of 2-31 months(15 months),the PFS of the control group 2 patients was 1-16 months(10 months)and OS was 2-34 months(15 months),and the PFS and OS of the observation group patients were 3-20 months(12 months)and 3-44 months(22 months),respectively.Kaplan-Meier sur‐vival curves showed that the PFS and OS of the observation group patients were longer than those of the control group 1 and control group 2 patients(P<0.05).Conclusion:Titanium clamp labeling under gastroscope is helpful to accurately delineate the target area of patients with unresectable locally advanced esophageal cancer,which can avoid the influence of inadequate radiotherapy dose after esophageal barium meal imaging and increased radiation dose of normal organs after CT scan localization,and can obtain reliable short-term efficacy and good long-term prognosis.