可手术食管癌采用手术与放射治疗的随机对照研究  

Randomized clinical study of surgery versus radiotherapy alone in the treatment of resectable esophageal cancer in the chest

作　　者：孙新东[1] 于金明[1] 范晓丽[1] 任瑞美[1] 李明焕[1] 张国丽[1] 

机构地区：[1]山东省肿瘤医院放射治疗科,济南250117

出　　处：《中华肿瘤杂志》2006年第10期784-787,共4页Chinese Journal of Oncology

摘　　要：目的探讨对可手术治疗的食管癌患者,采用后程加速超分割适形放射治疗与手术治疗的疗效。方法对269例可手术的胸段食管癌患者进行随机分组,手术组135例,放疗组134例。手术组距肿瘤上下缘各5 cm以上切除食管及其周围的淋巴脂肪组织,常规摘检≥5 mm的区域淋巴结。放疗组临床靶区(CTV)前程设野原则:胸上段食管癌包括双侧锁骨上区及病变下缘以下4 cm,胸中段食管癌上下缘各外放4 cm,胸下段食管癌包括上缘以上4 cm及胃左淋巴引流区,食管处宽度5～6 cm,以90％的等剂量曲线包绕CTV,设3～5个照射野,常规分割,每次1．8～2．0 Gy,照射50.0～50．4 Gy,然后缩野(病变上下缘各外放2 cm)加速超分割(1．5 Gy／次,2次／d,间隔≥6 h)照射18～21 Gy,总剂量为68．4～71．0 Gy。结果放疗组1、3、5年总生存率分别为88．6％、56．2％和34.7％,手术组分别为93．3％、61．5％和36．9％,两组间差异无统计学意义。手术组1、3、5年无进展生存率,分别为75．9％、43．7％和23．1％,放疗组分别为73．3％、39．7％和20．6％,两者间差异亦无统计学意义。结论可手术的食管癌采用后程加速超分割适形放射治疗,其疗效与手术治疗相当。Objective To compare the treatment results between radical surgery and late course accelerated hyperfractionated radiotherapy（LCAHFR） for patients with resectable esophageal cancer in the chest. Methods From June 1998 to September 2002, 269 patients with resectable esophageal cancer in the chest were randomized into two groups： 135 in surgery group and 134 in radiotherapy. The surgery group received esophagectomy including resection of the lesion and 5 cm margin at both ends from the lesion as well as surrounding lymph nodes ≥ 5 mm and fatty tissue. In the radiotherapy group： irradiation field for the lesion in the upper esophageal cancer included the gross lesion, bilateral supraclavicular nodes and 4 cm of normal esophagus from lower margin of the gross disease; for the esophageal cancer at the middle segment, it included the gross disease with 4 cm normal esophagus from both ends of the lesion; for the lesion in the lower esophageal cancer, it included 4 cm of normal esophagus and the gross lesion as well as the draining gastric lymph nodes. The width of the irradiation field was 5-6 cm. The 90% isodose volume was covered by the entire CTV with 3-5 beams, in a conventionally fractionated RT at 1.8-2.0 Gy/d for the first two thirds of treatment course to a dose of about 50-50.4 Gy followed by LCAHFR using reduced fields （2 cm extended margin at both ends of the lesion）, twice daily at 1.5 Gy per fraction（with aminimal interval of 6 h between fractions） to a dose of 18-21 Gy. The total dose whole radiotherapy was 68.4-71.0 Gy. Results The 1-, 3- and 5-year overall survival rate was 93.3%, 61.5% and 36.9% in the surgery group versus 88.6%, 56.2% and 34.7% in the radiotherapy group without statistical difference between the two groups. The 1-, 3- and 5-year progression free survival rate was 75.9%, 43.7% and 23.1% in the surgery group and 73.3%, 39.7% and 20.6%, respectively, in the radiotherapy group without statistical difference between the two groups either. Conelusion The results treated by

关 键 词：后程加速超分割适形放射治疗 食管肿瘤/放射疗法 食管肿瘤/外科学 

分 类 号：R735.1[医药卫生—肿瘤]