792例食管癌三维技术放疗的疗效分析  

Treatment outcomes of 792 cases of esophageal carcinoma patients treated with three-dimensionalradiotherapy

作　　者：孔洁[1] 李晓宁[1] 韩春[1] 王澜[1] 高超[1] 张靖[1] 田华[1] 肖爱勤[1] 麻国新[1] 

机构地区：[1]石家庄,河北医科大学第四医院放疗科,石家庄050011

出　　处：《中华放射肿瘤学杂志》2012年第5期421-424,共4页Chinese Journal of Radiation Oncology

基　　金：河北省强势特色学科课题资助（冀教高[2005]52号）

摘　　要：目的观察食管鳞状细胞癌三维技术放疗的局部控制率及生存率，并探讨影响因素。方法回顾分析2003－20HD8年收治的食管癌患者792例，采用三维适形放疗（672例）及调强放疗（120例）技术，1．8～2．0Gy／次，5次／周，处方剂量50～70Gy。同期放化疗142例，单纯放疗650例。Kaplan－Meier法计算局部控制率和生存率，幻卯以法单因素预后分析，Cox法多因素预后分析。结果随访率为95．8％，随访时间满5年者133例。全组1、3、5年局部控制率分别为76．6％、53．2％、48．6％，总生存率分别为70．1％、36．7％、28．0％。单因素预后分析显示T分期、N分期、临床分期、肿瘤体积为影响生存的因素（x＾2＝20．58～55．60，P均=0．000），多因素预后分析显示N分期、肿瘤体积为影响生存的因素（X。=6．35、29．23，P=0．012、0．000）。同期放化疗与单纯放疗的5年局部控制率分别为57．0％和46．8％（x＾2=7．34，P=0．007），5年总生存率分别为32．8％和27．6％（x＾2=3．42，P=0．064）。结论三维技术放疗食管癌的远期疗效较二维技术放疗明显提高。T分期、N分期、TNM分期、肿瘤体积是长期生存影响因素。加入同期化疗可提高患者的局部控制率。Objective To investigate the long term clinical result of three-dimensional radiotherapy for esophageal carcinoma , discuss the effect of correlative factors to survival and local control . Methods From July 2003 to December 2008, 792 patients with esophageal cancer were eligible. Patients were treated with three-dimensional radiotherapy （672 patients） or intensity-modulated （ 120 patients） radiotherapy. The radiotherapy was delivered in 1.8 - 2. 0 Gy per fraction, 5 fractions per week, total dose of 50 - 70 Gy, （median, 60 Gy）. 142 patients were treated by concurrent radiochemotherapy, and the other 650 patients radiotherapy alone. The local control rate and survival rate were calculated by Kaplan-Meier method. Logrank method was used for univariatc analyses. Cox regression model was used for multivariate analyses. Results The follow-up rate was 95.8%. The number of patients with 5 years time followed-up was 133. The l-year, 3-year and 5-year local control rates were 76. 6% , 53.2% , 48.6% , and the 1-year, 3-year and 5- year overall survival rates were 70. 1% , 36. 7% and 28. 0% , respectively. There were significant influence on the prognosis of T stage, N stage, TNM stage, tumor volume （ X^2 = 20. 58- 55.60, all P = 0. 000）. The Cox multivariate model showed that N stage and tumor volume were independent prognostic factors （X^2 = 6. 35,29.23, P = 0. 012, O. 000）. For the two groups of concurrent chemo-radiotherapy and radiotherapy alone, 5-year local control rates were 57. 0% and 46. 8% （X^2 = 7. 34, P = 0. 007 ） , the 5-year overall survival rate 32. 8% and 27. 6% （ X2 = 3.42, P = 0. 064. Conclusions Three-dimensional radiotherapy is effective for esophageal carcinoma. It might improve the local control rate and overall survival rate to some extent. T staging, N staging, TNM staging and tumor volume were important prognostic factors for long-term survival. The addition of concurrent radiochemotherapy could improve local control rates.

关 键 词：食管肿瘤/三维放射疗法 三维放射疗法 适形 三维放射疗法 调强 预后 

分 类 号：R735.1[医药卫生—肿瘤]