老年人食管癌三维适形放射治疗疗效分析  

Prognostic analysis of three-dimensional conformal radiotherapy for elderly patients with esophageal carcinoma

作　　者：王王祥[1] 祝淑钗[1] 苏景伟[1] 沈文斌[1] 刘志坤[1] 陶晓哲[1] 

机构地区：[1]河北医科大学第四医院放疗科,石家庄050011

出　　处：《中华老年医学杂志》2010年第2期131-134,共4页Chinese Journal of Geriatrics

基　　金：河北省卫生厅课题（06004）

摘　　要：目的探讨老年食管癌患者三维适形放射治疗（放疗）的疗效及其预后相关因素。方法回顾性分析2001年1月至2007年8月在我院接受三维适形放疗的89例65岁及以上老年食管癌患者的临床资料，分析生存率及预后的影响因素。结果全组1、2、3和4年局部无复发生存率分别为65．2％、43．0％、27．3％和22．3％。全组1、2、3和4年生存率分别为68．5％、48．8％、36．8％和25．2％，中位生存期21．5个月。单因素分析显示影响预后的因素有：放疗前进食情况（Х^2=6．26，P=0．012）、T分期（Х^2=8．80，P=0．003）、N分期（Х^2=4．33，P=0．038）、临床分期（Х^2=7．88，P=0．005）、CT显示瘤体最大直径（Х^2=10．88，P=0．004）、近期疗效（Х^2=5．28，P=0．022）、化疗（Х^2=5．49，P=0．019）；而性别（Х^2=0．74，P=0．390）、年龄（Х^2=1．89，P=0．170）、食管造影显示病变长度（Х^2=2．38，P=0．123）、CT显示病变长度（Х^2=2．69，P=0．101）、原发肿瘤部位（Х^2=2．12，P=0．146）、并存症（Х^2=0．03，P=0．874）、照射方式（Х^2=0．04，P=0．847）和放疗剂量（Х^2=0．24，P=0．627）与预后无关。Cox多因素分析显示治疗前进食情况（P=0．002）、临床分期（P=0．007）和化疗（P=0．011）为独立的预后影响因素。89例中发生0、1、2、3级急性期放射性食管炎分别为20、30、32、7例。发生0、1、2、3和5级急性放射性肺炎分别为57、20、8、2和2例。至随访结束已死亡60例，死于局部复发或病情未控制29例（48．4％）、死于远处转移11例（18．3％）、死于局部复发伴远处转移者5例（8．3％），其他原因死亡15例（25．0％）。结论老年食管癌患者三维适形放疗是安全有效的，放疗前进食梗阻轻、临床分期早，三维适形放疗预后好；反之预后差。联合化疗可以提高放疔疗效。Objective To explore the prognosis and its related factors of three-dimensional conformal radiotherapy （3D-CRT） for elderly patients with esophageal carcinoma. Methods From January 2001 to August 2007, 89 elderly patients aged 65 years or more with esophageal carcinoma were treated with 3D-CRT. And the local control rates, survival rates and its related prognostic factors were evaluated retrospectively, using SSPSll. 5 software. Results The 1 , 2 , 3- and 4-year local recurrence free survival rates were 65.2%, 43.0%, 27.3% and 22.3%, respectively. The 1-, 2-, 3- and 4-year overall survival rates were 68.5%, 48.8%, 36.8% and 25.2%, respectively. And the median survival time was 21.5 months. With univariate analysis, the significant prognostic factors included the different diet before radiotherapy （ Х^2=6.26, P=0.012）, T stage （Х^2 =8.80, P= 0. 003）, N stage （Х^2 =4.33, P=0. 038）, clinical stage （Х^2=7.88, P=0. 005） , the largest diameter of tumor in CT scanning image （Х^2=10.88, P=0. 004）, recent efficacy （Х^2 =5.28, P=0. 022） and chemotherapy （Х^2=5.49, P=0.019）. And the factors which were not related with prognosis included gender （Х^2=0.74, P 0.390）, age （Х^2=1.89, P=0.170）, lesion length showed by esophageal angiography （Х^2 =2.38, P=0. 123）, lesion length showed by CT （Х^2 =2.69, P=0. 101）,primary tumor site （Х^2= 2.12, P= 0. 146）, coexistent disease （Х^2= 0.03, P= 0. 874）, exposure mode （Х^2= 0. 04, P = 0. 847） and radiation dose （Х^2= 0.24, P = 0. 627）. Multivariate analysis revealed that the different diet before treatment （P = 0. 002）, the clinical stage （P = 0. 007） and chemotherapy （P = 0. 011） were independent prognostic factors. Radiation induced esophagitis was observed in 20 cases in grade 0, 30 cases in grade 1, 32 cases in grade 2, 7 cases in grade 3. And acute radiation pneumonitis was observed in 89 patients, with 57 in grade 0, 20 in grade 1, 8 in grade 2, 2 in grade 3 and 2 in grade 5. Until the end dat

关 键 词：食管肿瘤 放射疗法 计算机辅助 比例危险度模型 

分 类 号：R730.55[医药卫生—肿瘤] R735.1[医药卫生—临床医学]