食管癌根治术后吻合口复发的放射治疗  

Radiotherapy for anastomotic recurrence after radical resection of esophageal carcinoma.

作　　者：金晶[1] 王绿化[1] 殷蔚伯[1] 杨宗贻[1] 谷铣之[1] 

机构地区：[1]中国医学科学院中国协和医科大学肿瘤医院放射治疗科,北京100021

出　　处：《中华放射肿瘤学杂志》2000年第2期87-89,共3页Chinese Journal of Radiation Oncology

摘　　要：探讨食管癌根治术后吻合口复发放射治疗的价值。方法　病理确诊为食管癌且术后病理切缘阴性的 6 1例患者根治术后吻合口复发 ,复发时间在术后 3～ 16 1个月 ,中位时间 16个月。单纯吻合口复发 2 7例 ,吻合口复发伴纵隔淋巴结转移 34例。 46例在吻合口复发后接受放射治疗 (放射治疗组 ) ,10例化疗及 5例未治为非放射治疗组。结果　手术后 1、3、5年总生存率分别为88.5 %、31.2 %、19.7% ;复发后 1、3、5年生存率分别为 2 6 .3 %、3 .2 8%、1.6 4%。 >1年复发后的手术后 5年总生存率分别为 0 .0 %、31.4% (P <0 .0 1) ;5年复发后生存率分别为 0 .0 %、8.9% (P =0 .0 4)。单纯吻合口复发手术后 5年总生存率为 33 .3 % ,吻合口复发 +纵隔淋巴结转移手术后 5年总生存率为 5 .9% (P =0 .0 7)。放射治疗组的手术后 5年总生存率为 2 1.7% ,而非放射治疗组则为6 .7% (P =0 .0 2 ) ,且放射治疗组的复发后 1年生存率为 2 8.3% ,而非放射治疗组则为 0 .0 % (P <0 .0 1)。结论　手术后吻合口复发时间及是否接受放射治疗是影响预后的主要因素 ,单纯吻合口复发者的预后优于吻合口复发合并纵隔淋巴结转移者。Objective To assess the role of radiotherapy for anastomotic recurrence after radical resection of esophageal carcinoma. Methods From 1958 to December 1996, 61 patients who had negative margin but later developed anastomotic recurrence after resection of esophageal carcinoma were reviewed. All patients received surgery as a primary treatment. The duration from operation to recurrence was 3～161 months with a median of 16 months. Twenty-seven patients had anastomotic recurrence only and the remaining 34 patients had both anastomotic recurrence and mediastinal lymph node metastasis. Forty-six patients were treated with radiotherapy, and 15 patients with chemotherapy (10 patients) or simple observation (5 patients). Results The overall survivals at 1-, 3- and 5-year were 88.5%, 31.2%, and 19.7%, respectively. The corresponding post-recurrence survivals were 26.3%, 3.3%, and 1.6%, respectively. For patients relapsed within one year, the overall survival and post-recurrence survival at 5 years were 0.0% and 0.0% whereas for those relapsed more than one year after operation, the corresponding survivals were 31.4% and 8.9%, respectively. The difference was statistically significant. The overall 5-year survival was 33.3% for patients with anastomotic recurrence only and 5.9% for patients with both anastomotic recurrence and mediastinal lymph node metastasis (P=0.07). Patients treated with radiotherapy had a better prognosis than those treated with chemotherapy or observation. The overall 5-year survival was 28.3% for radiotherapy and 0.0% for observation, respectively (P<0.01). The 1-year post-recurrence survival was 28.3% for radiotherapy and 0.0% for observation or chemotherapy. Conclusions The duration from operation to anastomotic recurrence is an important prognostic factor. Radiotherapy for anastomotic recurrence is able to improve the local control rates and survivals.

关 键 词：食管肿瘤 放射疗法 复发 吻合口 

分 类 号：R735.1[医药卫生—肿瘤]