食管癌适形放疗预后因素的Cox模型分析  

Multivariate analysis of three dimensional conformal radiotherapy for esophageal carcinoma

作　　者：王澜[1] 韩春[1] 张辛[1] 王军[1] 麻国新[1] 肖爱勤[1] 

机构地区：[1]河北医科大学第四医院放疗科,河北石家庄050011

出　　处：《中华肿瘤防治杂志》2009年第1期58-61,共4页Chinese Journal of Cancer Prevention and Treatment

基　　金：河北省高校强势特色学科资助课题(冀教高[2005]52号)

摘　　要：目的:观察食管癌三维适形放疗疗效,对各项相关因素进行单因素、多因素预后分析,以求得到合理的预测性指标。方法:100例首程治疗的食管癌患者接受三维适形放射治疗,全组处方剂量56～70Gy,中位处方剂量64Gy,2Gy/次,1次/d,5次/周。观察其疗效,对患者的一般临床因素和肿瘤局部因素进行单因素、多因素预后分析。结果:全组患者完全缓解(CR)64例(65%),部分缓解(PR)34例(34%),无缓解(NR)2例,肿瘤总有效率(CR+PR)为98%。1、2和3年局部控制率分别为73.49%、55.21%和42.77%,1、2和3年总生存率分别为73.25%、48.09%和43.39%,中位生存期24个月。单因素分析显示,处方剂量、近期疗效、≥2级的放射性肺炎发生情况、肿瘤T和N分期、GTV长度、最大横径及GTV体积为食管癌患者放疗的预后因素;多因素分析显示,GTV体积、≥2级的放射性肺炎发生情况和近期疗效是预后的独立影响因素。对于肿瘤体积较大的患者,处方剂量≤64Gy组与>64Gy组的1、2和3年生存率分别为56.75%、56.75%、28.37%和52.94%、24.06%、24.06%,χ2=0.15,P=0.6964。结论:三维适形放疗是治疗食管癌的有效手段,肿瘤局部因素对其预后具有较好的预测性,GTV体积、≥2级的放射性肺炎发生情况和近期疗效是独立的影响因素,对肿瘤体积较大的患者不宜强行追求高剂量照射。OBJECTIVE： To observe the clinical results of three dimensional conformal radiotherapy （3DCRT） for esophageal carcinoma and analyze the correlative factors for reasonable predictors. METHODS： One hunderd patients with esophageal carcinoma received three dimentional conformal radiotherapy. The median prescription dose was 64 Gy （range, 56 70 Gy）, 2 Gy per frac tion, 1 fraction per day, and 5 fractions per week. The clinical resuits and side effects were evaluated. Univariate and multivariate analysis were performed to test the association between the correlative factors and prognosis. RESULTS： There were 64 patients reached complete remission （CR） and 34 patients partial remission （PR）, and the overall response rate （CR＋PR） was 98%. The one , two-, three-year local control rates were 73.49%, 55.21% and 42.77%, respectively. The one-, two-, three year overall survival rates were 73.25%, 48.09% and 43.39%, respectively. The median survival time was 24 months. Univariate analysis indicated that the prescription dose, short term result, development of χ^2 grade radiation pneumonitis （RP）, T stage, N stage, the length and maximum diameter of GTV, and the volume of GTV were cor relative factors of prognosis. Of that the volume of GTV, development of χ^2 grade RP and the short term result were independently associated with prognosis. For the patients who had relatively large tumors, the one, two, three-year survival rate of prescription dose ≤64 Gy group and 〉64 Gy group were 56.75%, 56.75%, 28.37% and 52.94%, 24.06%, 24.06%, respectively. CONCLUSIONS： The technique of three dimensional conformal radio therapy is an effective method for esophageal carcinoma. The local factors of tumor are well predictors of prognosis. The volume of GTV, development of ≥2 grade RP and short term result are independent predictors. It is not in need of high doses to large tumors.

关 键 词：食管肿瘤 成像 三维 放射疗法 计算机辅助 预后 

分 类 号：R735.1[医药卫生—肿瘤]