Correlation of plasma miR-21 and miR-93 with radiotherapy and chemotherapy efficacy and prognosis in patients with esophageal squamous cell carcinoma

BACKGROUND Esophageal squamous cell carcinoma(ESCC)is one of the main causes of human death.It is usually already in middle or advanced stage when diagnosed due to its hidden symptoms in early stage.Therefore,patients have already lost the best surgical timing when diagnosed.Radiotherapy and chemotherapy are standard treatment methods for ESCC clinically,but the efficacy and prognosis of patients from them are still unsatisfactory.Therefore,it is of great clinical significance to seek for biomarkers that can predict the radiotherapy and chemotherapy response and prognosis of ESCC patients.AIM To explore the clinical value of plasma miR-21 and miR-93 in ESCC.METHODS A total of 128 ESCC patients admitted to the First Affiliated Hospital of Zhenzhou University were enrolled as a study group and treated with concurrent radiotherapy and chemotherapy,and other 45 healthy people during the same period were enrolled as a control group.The expression of plasma miR-21 and miR-93 was determined using quantitative real-time polymerase chain reaction,and the correlation of expression of plasma miR-21 and miR-93 with clinical pathological parameters about the patients was analyzed.The receiver operating characteristic(ROC)curve was adopted to assess the diagnostic value of plasma miR-21 and miR-93 for clinical pathological features of ESCC patients,the Logistic regression analysis adopted to analyze the risk factors for radiotherapy and chemotherapy efficacy in ESCC patients,and the Cox regression analysis to identify the prognostic factors for ESCC patients.RESULTS The study group showed significantly higher relative expression of plasma miR-21 and miR-93 than the control group(P<0.01).The area under the ROC curve(AUC)of plasma miR-21 for diagnosing T stage,N stage,M stage,and pathological differentiation of ESCC was 0.819,0.758,0.824,and 0.725,respectively,and that of plasma miR-93 for diagnosing T stage,N stage,and M stage of ESCC was 0.827,0.815,and 0.814,respectively.The AUC of combined plasma miR-21 and miR-93 for predicting radiotherapy and chemotherapy efficacy before radiotherapy and chemotherapy was 0.894,and the AUCs of them for predicting the 3-year overall survival(OS)were 0.861 and 0.807,respectively.T stage(P<0.05),M stage(P<0.05),miR-21(P<0.01),and miR-93(P<0.05)were independent risk factors for radiotherapy and chemotherapy efficacy,and T stage(P<0.01),N stage(P<0.05),M stage(P<0.01),miR-21(P<0.01),and miR-93(P<0.01)were independent prognostic factors for ESCC patients.CONCLUSION MiR-21 and miR-93 can be adopted as effective biomarkers for predicting radiotherapy and chemotherapy efficacy in ESCC and the 3-year OS of ESCC patients.

Concurrent chemoradiotherapy combined with enteral nutrition support:a radical treatment strategy for esophageal squamous cell carcinoma patients with malignant istulae

Background: Concurrent chemoradiotherapy(CCRT) significantly increases the survival rate of esophageal squa?mous cell carcinoma(ESCC) patients with malignant fistulae. Recent clinical evidence has shown the benefits of enteral nutrition for malnourished cancer patients. In this study, we aimed to validate that, with the support of enteral nutrition, ESCC patients who develop malignant fistulae might be able to complete CCRT and achieve long?term survival.Methods: We reviewed the medical records of 652 patients with ESCC who received definitive CCRT at Sun Yat?sen University Cancer Center between January 2010 and December 2012. Treatment outcome and toxicity were ret?rospectively evaluated in 40 ESCC patients with malignant fistulae. All the 40 patients were treated with CCRT and evaluated by clinical nutritionists using nutrition risk screening(NRS) before, during, and after treatment. Twenty?two patients received a nasogastric tube, and 18 underwent percutaneous endoscopic gastrostomy feeding. The median energy intake was 2166 kcal/day. Treatment response was evaluated at 3 months after the completion of CCRT.Results: With a median follow?up of 18 months(range, 3–39 months), patients' 1?year overall survival(OS) rate was 62.5%, and the estimated OS time was 25.5 months. Univariate analysis showed that the NRS score(P n NRS score(P se to treatment(P < 0.001) were sig= 0.003), increase i= 0.024), fistula closure(P = 0.011), and responnifi?cantly associated with OS. Multivariate analysis showed that tumor response(P = 0.044) and increase in NRS score(P = 0.044) were independent predictors of OS. Grade 3 vomiting was observed in 8 patients(20.0%), grade 3 neutro?penia was observed in 11 patients(27.5%), and grade 3 cough was observed in 13 patients(32.5%); 2 patients(5.0%) died of massive bleeding during treatment.Conclusions: CCRT combined with enteral nutrition support is effective for ESCC patients with malignant fistulae. Patients have an increased potential to be cured, especially those who experience complete response and have an increase in NRS score. Careful observation and nutrition support are required for patients with advanced T?category ESCC who undergo CCRT.

Neoadjuvant chemoradiotherapy for esophageal cancer:Impact on extracapsular lymph node involvement

AIM:To assess the effects of neoadjuvant chemoradiotherapy(CRT) on the presence of extracapsular lymph node involvement(LNI) and its prognostic value in patients with resected esophageal cancer.METHODS:Two hundred and ninety-eight patients with advanced esophageal cancer underwent esophagectomy between 1997 and 2006.One hundred and ninety patients(63.8%) were treated with neoadjuvant CRT prior to resection.A total of 986 metastatic LNs were examined.Survival of the patients was analyzed according to intra-and extra-capsular LNI.RESULTS:Five-year survival rate was 22.5% for the entire patient population.Patients with extracapsular LNI had a 5-year survival rate of 16.7%,which was comparable to the 15.8% in patients with infiltrated nodes of the celiac trunk(pM1lymph).In contrast to patients treated with surgery alone,neoadjuvant therapy resulted in signif icantly(P = 0.001) more patients with pN0/M0(51.6% vs 25.0%).In 17.6% of the patients with surgery alone vs 16.8% with neoadjuvant CRT,extracapsular LNI was detected.Neoadjuvant therapy does not reduce the occurrence of extracapsular LNI.CONCLUSION:Extracapsular LNI is an independent negative prognostic factor not influenced by neoadjuvant CRT.In a revised staging system for esophageal cancer,extracapsular LNI should be considered.

Principle and progress of radical treatment for locally advanced esophageal squamous cell carcinoma

Esophageal squamous cell carcinoma is one of the most common malignant tumors in the digestive system in China and the world.Most patients are diagnosed as locally advanced or advanced stage.Concurrent chemoradiotherapy is the standard treatment for locally advanced esophageal squamous cell carcinoma.This study intends to summarize the evidence-based medical evidence of the treatment principle of locally advanced esophageal squamous cell carcinoma,the selection of radiotherapy dose,the outline of radiotherapy target and the selection of chemotherapy scheme.As a result,the effect of radiotherapy and chemotherapy is equivalent to that of surgery for the radical treatment of esophageal squamous cell carcinoma.In the era of immunization,it is recommended to use involved field irradiation.Fluorouracil plus cisplatin regimen is the standard chemotherapy regimen.FOLFOX regimen and paclitaxel plus fluorouracil regimen are optional concurrent chemotherapy regimens.The toxic and side effects of different chemotherapy regimens are different,which can be selected according to the actual situation of patients.

Induction chemotherapy with albumin-bound paclitaxel plus lobaplatin followed by concurrent radiochemotherapy for locally advanced esophageal cancer

BACKGROUND Albumin-bound paclitaxel(ABP)has been used as second-and higher-line treatments for advanced esophageal cancer,and its efficacy and safety have been well demonstrated.Lobaplatin(LBP)is a third-generation platinum antitumor agent;compared with the first two generations of platinum agents,it has lower toxicity and has been approved for the treatment of breast cancer,small cell lung cancer,and chronic granulocytic leukemia.However,its role in the treatment of esophageal cancer warrants further investigations.AIM To investigate the efficacy and safety of induction chemotherapy with ABP plus LBP followed by concurrent radiochemotherapy(RCT)for locally advanced esophageal cancer.METHODS Patients with pathologically confirmed advanced esophageal squamous cell carcinoma(ESCC)at our hospital were enrolled in this study.All patients were treated with two cycles of induction chemotherapy with ABP plus LBP followed by concurrent RCT:ABP 250 mg/m^(2),ivgtt,30 min,d1,every 3 wk;and LBP,30 mg/m^(2),ivgtt,2 h,d1,every 3 wk.A total of four cycles were scheduled.The dose of the concurrent radiotherapy was 56-60 Gy/28-30 fractions,1.8-2.0 Gy/fraction,and 5 fractions/wk.RESULTS A total of 29 patients were included,and 26 of them completed the treatment protocol.After the induction chemotherapy,the objective response rate(ORR)was 61.54%,the disease control rate(DCR)was 88.46%,and the progressive disease(PD)rate was 11.54%;after the concurrent RCT,the ORR was 76.92%,the DCR was 88.46%,and the PD rate was 11.54%.The median progression-free survival was 11.1 mo and the median overall survival was 15.83 mo.Cox multivariate analysis revealed that two cycles of induction chemotherapy followed by concurrent RCT significantly reduced the risk of PD compared with two cycles of chemotherapy alone(P=0.0024).Non-hematologic toxicities were tolerable,and the only grade 3 non-hematologic toxicity was radiation-induced esophagitis(13.79%).The main hematologic toxicity was neutropenia,and no grade 4 adverse event occurred.CONCLUSION Induction chemotherapy with ABP plus LBP followed by concurrent RCT is effective in patients with locally advanced ESCC,with mild adverse effects.Thus,this protocol is worthy of clinical promotion and application.

Ⅲ期食管癌同步放化疗与序贯性放化疗疗效比较

背景与目的：食管癌有早期扩散和转移的倾向，单纯放射治疗的生存率不高，复发率甚高，即使提高放疗技术也无法提高牛仔率。目前对于癌症的治疗提倡综合治疗。本研究比较同步放化疗与序贯化放疗对Ⅲ期未手术的食管癌的近期疗效，毒副反应和长期生存率。方法：70例Ⅲ期食管癌随机分为两组，36例列入同步放化疗组，34例列入序贯化放疗组。同步放化疗组男性30例，女性6例，平均年龄60岁（范围41～70岁），病变部位，上段18例．中段10例，下段8例，病变长度6．42±1．35cm；序贯化放疗组男性28例，女性6例，平均年龄62岁（范围42～68岁），病变部位，上段16例，中段11例，下段7例，病变长度6．35±1．53cm。化疔方案：5-FU500mg／m^2，静脉滴注d1-4，DPP70mg／m^2，静脉滴注d1，3周一疗程，共2疗程。同步放化疗组：在化疗第一天即进行放疗。序贯化放疗组：在2疗程化疗后，第43天起放疗。放疗方法均为：6MV X线三野等中心照射，2Gy／（次、天），5次／周，共6周，肿瘤剂量为60Gy。结果：同步放化疗组CR11例（30．5％），PR20例（55．5％）近期有效率（CR＋PR）为86．1％，序贯化放疗组：CR4例（11．8％），PR18例（52．9％）近期有效率（CR＋PR）为64．7％，（X^2=4．106，P=0．043和X^2=4．357，P=0．037），差异有显著意义。1、2、3年生存率两组分别为75．0％，66．7％，33．3％和67．6％，43．5％，30．0％，两组间的生存率经X^2检验，未显示有差异，但1、2、3年局控率有明显差异性分别为80．6％、62．1％，44．4％VS70．6％．54．2％．23．1％（X^2=8．411，P=0．015）。同步放化疔组的毒副反应尤其是血白细胞和放射性食管炎均大于序贯化放疗组（X^2=8．826，P=0．004和X^2=1．348，P=0．001），但Ⅲ＋Ⅳ度反应无差异（P〉0．05），并且患者均能接受．结论：以5-Fu和DDP化疗同步放疗可提高llI期食管癌的近期有效率和局控率，有增加长期生存率的趋势，毒副反应虽大于序贯化放疗组，但患者均能接受。

同步放化疗联合多西他赛和顺铂巩固化疗在老年食管癌中的疗效分析

目的:探讨多西他赛和顺铂(docetaxel and cisplatin,DP)同步放化疗后巩固化疗对老年食管癌的疗效。方法:79例老年食管癌患者随机分为试验组(38例)和对照组(41例)。两组均采用调强放疗,处方剂量为56.0~59.4 Gy,共28~33次,同步化疗为多西他赛25 mg/m^2+顺铂25 mg/m^2,每7 d 1次。完成同步化疗后,试验组巩固化疗方案为:多西他赛60 mg/m^2,第1,8天;顺铂75 mg/m^2,第1~5天,每21 d 1个周期,共4周期。对照组仅继续观察。结果:共76例患者可评价疗效。试验组获完全缓解(complete response,CR)10例,部分缓解(partial response,PR)21例,稳定(stable disease,SD)4例,进展(progressive disease,PD)2例,有效率(objective response rate,ORR)为89.2%;对照组获CR9例,PR15例,SD8例,PD7例,ORR为61.5%。两组ORR差异有统计学意义(P=0.030)。试验组和对照组的中位无进展生存期分别为19.7和10.8个月,差异有统计学意义(P=0.04)。试验组的1,2,3年生存率分别为78.5%,57.9%和37.8%,对照组分别为61.2%,42.3%和22.7%(P=0.08)。两组毒副作用均以1~2级为主,3~4级较少见,主要毒副作用表现为血液学毒性及放射性食管炎,试验组整体毒副作用略高于对照组,两组比较差异无统计学意义(P>0.05)。结论:老年食管癌患者采用同步放化疗联合DP方案巩固化疗,可以明显提高患者的疾病缓解率,延长无进展生存期。

食管癌放疗后食管狭窄的相关因素分析

目的:研究食管癌放疗后食管狭窄形成的影响因素。方法:62例原发性食管癌患者在2005年10月至2008年6月间接受了放疗或放化疗联合治疗。治疗后定期随访患者的食管钡餐造影,评价食管狭窄情况,计算狭窄率,观察食管狭窄峰值出现的时间。并对患者年龄、肿瘤的位置、T分期、肿瘤侵犯食管全周的比例(周在性)、纵轴长度、放疗剂量、化疗参与等因素与放疗后发生食管狭窄进行相关性分析。结果:在16个月的中位随访时间内,共有27例(43.5%)患者出现了中度以上(狭窄率>50%)的食管狭窄。食管狭窄出现的高峰时间在放疗后5～8个月之间。单因素分析提示T分期、肿瘤侵犯管壁的周在性及无化疗参与为狭窄发生的相关因素(P值分别为0.0177、<0.0001和0.0034)。多因素分析的结论是周在性与无化疗参与对放疗后食管狭窄有显著影响意义(P值分别为<0.001和0.0011)。结论:在放疗剂量为60Gy左右的前提下,肿瘤在管腔内的周在性与放疗后狭窄的形成呈正相关,化疗的参与可能会降低食管狭窄的形成,放疗剂量与狭窄形成的关系在本研究中未得到确切证实。

食管癌术后复发患者调强放疗同步化疗(5-Fu+奈达铂)的Ⅱ期临床研究

目的评价食管癌根治术后复发患者调强放疗同步化疗(5-Fu+奈达铂)的近期疗效和不良反应。方法选取2009年6月—2010年6月44例符合入组条件的食管癌术后复发患者,均采用调强放疗同步化疗(5-Fu+奈达铂)方案进行治疗。调强放疗:GTV给量60 Gy/30f,2.0Gy/f;CTV给量54 Gy/30f,1.8Gy/f。同步化疗在放疗的第1周和第4周进行,具体为:5-Fu 750 mg/(m2.d),d1～5,奈达铂80 mg/(m2.d),d1。主要观察终点是1年生存率,次要观察终点是不良反应。结果全组总有效率为86%(38/44)。1年和2年总生存率分别为72.7%和60%。1年和2年无进展生存率分别为63.6%和36.6%。放化疗期间出现Ⅰ、Ⅱ和Ⅲ度骨髓抑制的患者分别为16%(7/44)、50%(22/44)和34%(15/44);出现Ⅰ度和Ⅱ度胃肠道反应的患者分别为45%(20/44)、55%(24/44);出现Ⅰ度和Ⅱ度肝/肾功能生化指标异常的患者分别为77%(34/44)、23%(10/44),未发现Ⅲ度及以上胃肠道及肝/肾功能生化指标异常者。所有不良反应经对症处理后均好转,全组患者均顺利完成放化疗计划,无疗程中断或延迟者。结论食管癌根治术后复发患者进行调强放疗同步化疗(5-Fu+奈达铂)的近期疗效好,不良反应小,值得进行Ⅲ期临床研究。

中晚期食管癌系列治疗和手术后并发症防治研究

目的对中晚期食管癌系列治疗方法行了评价。方法对食管癌单纯放疗、放疗的同时给予化疗、单纯手术、术前放疗+手术和手术+术后“T”放疗的效果进行了比较分析,对术前化疗+手术+术后放疗或化疗进行了临床观察和理论上探讨;对术后各种并发症采取预防措施。结果单纯放疗组5年生存率为22%,单纯手术组为33.18%,放疗同时化疗组为14%,手术+术后“T”放疗组为41.7%,术后并发症逐年减少,病死率下降。结论手术根治仍是食管癌重要治疗方法,“二野”手术后“T”放疗临床研究取得了“三野”手术的5年存活率效果。术前化疗+标准手术+术后放疗和化疗是提高食管癌远期生存率的优化方案。

放疗联合周剂量奈达铂治疗老年食管癌的临床研究

目的:探讨放疗联合周剂量奈达铂治疗老年食管鳞癌患者的疗效及毒性。方法:选取49例老年食管癌患者,随机分为奈达铂每周化疗同步放疗(同步组)24例和单纯放射治疗(单放组)25例,两组放疗均采用常规分割,照射剂量60～66 Gy。同步组奈达铂30mg/m^2每周1次,连续6周。结果:同步组完全缓解10例,部分缓解11例,有效率87.5%,单放组完全缓解4例,部分缓解11例,有效率60.0%,两组比较差异有统计学意义(P<0.05)。同步组2～3度白细胞下降占54.2%,明显高于单放组的20.0%(P<0.05),同步组3度血小板下降3例,单放组无3度血小板下降病例。两组2～3度放射性食管炎发生率差异无统计学意义(37.5%vs 32.0%)。结论:奈达铂每周化疗同步放疗治疗老年食管癌近期疗效较好,骨髓抑制稍加重但可耐受。

介入化疗联合放疗治疗中晚期食道癌临床观察

目的:探讨动脉灌注化疗联合放射治疗中晚期食管癌的临床应用价值。方法:入选2006年6月～2010年7月在我院肿瘤科住院治疗的中晚期食道癌患者138例,根据治疗方法的不同分为观察组(动脉灌注化疗联合放射观察组)与对照组(单纯放射观察组)。结果:治疗后,观察组完全缓解率和总有效率分别为58.1%、91.9%,显著高于对照组35.5%和73.7%,差异具有统计学意义(P<0.05)。两组患者治疗期间并发症差异无统计学意义(P>0.05)。治疗后随访3年,观察组随访1年、2年、3年的生存率分别为69.4%、58.1%、46.8%,显著高于对照组44.7%、34.2%、22.4%,差异均有统计学意义(P均<0.01)。结论:单纯的放疗能改善患者的症状,但是在其基础上联合介入化疗,更显著改善患者的症状,提高患的预后。

原发性食管小细胞癌的研究进展

原发性食管小细胞癌是非常少见的食管恶性肿瘤,近年来食管小细胞癌的发病率似有上升趋势.食管小细胞癌的生物学行为、治疗模式及预后均不同于鳞状细胞癌,其恶性程度高、预后差,目前尚无统一的治疗规范.本文就近几年来有关食管小细胞癌的研究进展作一综述.

局限期小细胞食管癌不同治疗方式的回顾性研究及预后因素分析

目的 探讨不同治疗方式对局限期小细胞食管癌（SCEC）患者生存期的影响及预后因素.方法 根据治疗方式不同将本院1998年3月至2007年3月间收治并经病理确诊的106例局限期SCEC分为4组：单纯手术组（14例）、手术＋术后化疗组（42例）、单纯放疗组（11例）和放化疗组（39例）,回顾性分析4组的5年生存率、中位生存期及远处转移情况,同时采用Cox多元回归模型分析影响预后的因素.结果 在106例局限期SCEC患者中,联合化疗和未联合化疗者的5年生存率分别为27.2％和0,中位生存期分别为22.0个月和11.0个月,后者的死亡风险比（HR）为2.30（95％ CI：1.42～3.73,P=0.001）.放化疗组和手术＋术后化疗组的5年生存率分别为23.1％和31.0％,中位生存期分别为18.0个月和26.0个月,前者的死亡HR为1.25（95％CI：0.75～ 2.09,P=0.725）.Cox多因素分析显示化疗是影响预后的独立因素,未化疗的死亡HR为2.92（95％ CI：1.25～6.80）.结论 对于局限期SCEC,以化疗为主的综合治疗模式可能有益,手术＋术后化疗与放化疗的总生存情况相似.化疗是影响局限期SCEC患者预后的独立因素,其最佳治疗模式尚需前瞻性随机对照研究.

同步放化疗治疗与手术治疗对食管癌患者生活质量影响的比较分析

目的:探讨同步放化疗治疗和手术治疗对食管癌患者生活质量(QOL)的影响。方法:160例已确诊的食管癌患者,其中放化疗组和手术组各80例,采用欧洲癌症研究与治疗组织(EORTC)的肿瘤患者QOL核心量表QLQ-C30和食管癌专用量表QLQ-OES18对每例患者治疗后6个月、12个月进行QOL测评,并随访至少5年的生存状态。结果:QLQ-C30测评发现,放化疗组治疗后6个月、12个月的整体QOL、躯体功能、角色功能、认知功能、情绪功能、社会功能的评分,均高于手术组,差异有统计学意义(P<0.05);而在QLQ-OES18各项测评中,放化疗组除口干、咳嗽、言语表达等项目外,其他各项评分在治疗后的6个月、12个月均低于手术组,差异有统计学意义(P<0.05)。经Kaplan-Meier分析,手术组患者5年生存率为43.1%,放化疗组患者5年生存率为42.2%,差异无统计学意义(P>0.05)。结论:食管癌患者行同步放化疗后6个月、12个月的QOL较行手术治疗患者的QOL高。

卡培他滨联合三维适形放疗治疗老年中晚期食管癌的临床疗效观察

目的探讨卡培他滨联合三维适形放疗治疗老年中晚期食管癌的近期疗效及其不良反应。方法选择2010年12月至2012年10月我院收治的45例老年中晚期食管癌患者并将其随机分为两组:单纯放疗组22例(对照组),放疗同步卡培他滨组23例(试验组)。对照组全程采用常规分割照射,1次/天,2Gy/次,5次/周,总剂量60～66Gy/30～33次/6～7周。试验组放疗方法同对照组,患者在放疗期间口服卡培他滨1000mg·m-2,2次/天,连用14天后停药7天,21天为一个疗程,共治疗2个疗程。治疗结束后比较两组患者的临床疗效及其不良反应的发生情况。结果 45例患者均按计划完成治疗,放疗结束后第8周复查,对照组和试验组的治疗总有效率分别为63.6%和82.6%,差异有统计学意义(P<0.05)。试验组手足综合征及腹泻的发生率显著高于对照组(P<0.05),均为Ⅰ～Ⅱ级,两组其它不良反应如骨髓抑制、恶心、呕吐、放射性食管炎及放射性肺炎的发生率的差异均无统计学意义(P>0.05)。结论相对于单纯放疗,卡培他滨联合三维适形放疗技术可提高老年中晚期食管癌的近期疗效,患者的不良反应有所增加,但患者均可耐受,值得临床进一步探讨。

食管癌新辅助放化疗患者血清肿瘤标记物水平动态变化及意义

目的探讨血清肿瘤标记物水平动态变化判断食管癌新辅助放化疗患者疗效及预后的价值。方法对30例行新辅助放化疗食管癌切除术患者的血清细胞角化素蛋白片段19(CYFRA21-1)、癌胚抗原(CEA)及糖链抗原19-9(CA19-9)水平行动态观察,分析其变化与临床疗效及预后的关系。结果治疗前CEA阳性者中位生存期明显短于CEA阴性者,P<0.05;CA19-9阳性者中位生存期短于CA19-9阴性者(但因阳性例数过少,无法行统计学处理);CYFRA21-1阳性与阴性者中位生存期无统计学差异。治疗过程中标志物呈下降趋势者中位生存期长于、有效率高于呈上升趋势者,P均<0.05。结论对食管癌新辅助放化疗患者血清CYFRA21-1、CEA及CA19-9联合动态及变化趋势检测,可评价治疗效果及判断预后。

化疗加放疗及单用放疗治疗晚期食管癌82例疗效分析

１９９０年１月至１９９４年１０月对８２例晚期食管癌随机分组研究，化疗加放疗（综合组）和单用放疗（单放组）两组进行对比研究。结果综合组与单放组１年生存率分别为６８．３％和４６．３％，３年生存率３４．８％和８．７％，Ｐ＜０．０５均有显著性差异。合并有锁骨上淋巴结转移病例中综合组与单放组１年生存率６３．６％和４０％，Ｐ＜０．０５有显著性差异，但３年生存率２８．６％和８．３％，Ｐ＞０．０５无显著性差异。食管病变长度与预后在本实验中无密切关联。近期疗效综合组ＣＲ率高于单放组，吞咽症状改善情况也比单放组好。

食管癌IMRT计划设计降低子野数及MU数方法研究

目的:研究降低食管癌调强计划子野数及MU数的可行性方法。方法:(1)射野方向:IMRT计划由物理师按照经验非均匀共面布野。(2)优化强度级数:分别设计为12、10、8、6优化强度级数。(3)围绕PTV连续定义六个和PTV同心的空心环并限制每个环剂量的计划(4)直接子野优化方法:使用DMPO模式设计,该模式允许预先设定最多子野数。结果:(1)选择的共面非均匀布野与均匀布野调强计划相比,肿瘤靶区的适形度、均匀性较好,总子野数和MU数无差异。(2)优化强度级数为12、10和8的计划质量基本相当,都满足食管癌临床要求,但优化强度级数为8的计划总子野数减少17%,MU数基本不变。(3)设定同心环并限制每个环剂量的计划,肿瘤受照剂量的适形度和正常组织受量均明显好于没有设定椭圆环的调强计划,同时该计划总子野数减少23%、总MU数减少9%。(4)与两步法调强计划相比,DMPO模式PTV的适形度更好,总子野数比原计划减少37%,总MU数减少16%。结论:通过优化强度级数选择、定义治疗靶区同心空心环、直接子野优化等方法,在不改变甚至提高原计划质量的前提下,可以减少食管癌IMRT计划总子野数和MU数。

食管小细胞癌治疗与预后的系统评价

目的:分析以往文献数据,探讨食管小细胞癌的主要临床特征,并对其治疗方法与预后关系作系统评价。方法:检索PubMed、Embase、Ovid数据库1990年-2012年10月发表的所有相关文献,按照严格的纳入排除标准纳入相关研究,提取文献数据,采用SPSS 13.0统计软件进行数据分析。结果:共获得食管小细胞癌病例441例。男性304例,女性78例。首发症状以进食哽咽/咽下困难(81.12%)最为常见。病变位于颈段、胸上段、胸中段、胸下段及多段者分别占0.97%、8.71%、47.74%、40.65%和1.94%。36%的患者首诊时为广泛期。局限期和广泛期SCEC患者中位生存时间分别为16个月和10个月,1、2、3、5年生存率分别为62.75%/43.37%(P=0.004)、32.03%/9.64%(P<0.001)、18.30%/4.82%(P=0.004)、10.46%/2.41%(P=0.014)。局限期食管小细胞癌的治疗:综合治疗较单纯局部治疗6个月及1年生存率分别为94.39%/59.38%(P<0.001)和73.83%/40.63%(P=0.001)。综合治疗较单纯化疗6个月、1年、2年、3年生存率分别为94.39%/35.71%(P<0.001)、73.83%/28.57%(P=0.001)、38.32%/7.14%(P=0.021)、23.36%/0.00%(P=0.042)。手术+化疗、放疗+化疗及手术+放疗+化疗三种治疗方法总体生存率无明显差异。广泛期患者综合治疗组与化疗组的6个月生存率分别为91.43%/61.11%(P=0.011)。结论:原发性SCEC发病率低,恶性度高,采取局部治疗+化疗的治疗方法有助于延长患者的生存期,但手术的应用对于改善局限期SCEC患者的预后无明显意义。广泛期SCEC患者的治疗仍以局部治疗+化疗的综合治疗为首选方案。