食管胸段鳞癌术后预防照射靶区初步分析  

Target volume of prophylactic radiotherapy in postoperative thoracic esophageal squamous cell carcinoma

作　　者：蔡文杰[1] 辛培玲[1] 陈雅云[1] 

机构地区：[1]福建医科大学附属泉州第一医院放疗科,福建泉州362000

出　　处：《中华肿瘤防治杂志》2012年第18期1403-1406,共4页Chinese Journal of Cancer Prevention and Treatment

基　　金：福建省医学创新课题(2011-CXB-30)

摘　　要：目的:探讨胸段食管鳞癌术后复发、转移的临床特征,了解术后放疗的靶区范围。方法:回顾性分析140例食管胸段鳞癌患者术后复发转移部位。结果:140例术后复发转移病例,中位进展时间18.3个月(15.4～21.1个月)。吻合口复发占治疗失败13.6%,在所有部位的食管胸段鳞癌中,锁骨上、1～5区和7区淋巴结转移率高。3区、4区转移率从高到低排列是胸中段、胸上段和胸下段食管癌。而上腹部淋巴结转移率从高到低排列是胸下段、胸中段和胸上段食管癌。局部复发是治疗失败的最主要形式。结论:对于食管胸上段和胸中段鳞癌来说,吻合口、锁骨上、1～5区和7区应该作为术后预防照射的靶区,不必包上腹部淋巴结区。而食管胸下段鳞癌吻合口、锁骨上、1～5区和7区和上腹部淋巴结可能是术后预防性放疗的靶区。OBJECTIVE： To provide a reference for determination of the postoperative radiotherapy target volume for thoracic esophageal squamous cell carcinoma. METHODS： One hundred forty patients with recurrent or metastatic thoracic esophageal squamous cell carcinoma who had been treated with radical surgery but not with postoperative radiotherapy were enrolled in this study. The information of loeoregional recurrence and distant metastasis for these patients was ana- lyzed. RESULTS： The median time to progression in the 140 patients with recurrence or metastasis was 18. 3 months （range 15.4-21.1 months）. Anastomotic recurrence accounted for 13.6% of treatment failures. The supraclavicular and station 1- 5 and 7 lymph nodes had high metastasis rates for esophageal squamous cell carcinomas in all locations. The or- der from highest to lowest metastasis rate for the station 3 and 4 lymph nodes was middle,upper and lower thoracic esoph- ageal regions, and the order for upper abdominal lymph nodes was lower, middle, and upper thoracic esophageal regions. Locoregional recurrence was the most common type of recurrence. CONCLUSION： For upper and middle thoracic esopha- geal squamous cell carcinomas, the anastomosis, supraelavieular,and station 1-5 and 7 lymph nodes should be delineated as the postoperative prophylactic irradiation target volume with upper abdominal lymph nodes excluded; for lower thoracic esophageal squamous cell carcinomas, anastomosis, supraclavieular, station 1- 5 and 7 lymph nodes and upper.

关 键 词：食管肿瘤 外科学 食管肿瘤 放射疗法 靶区 

分 类 号：R735.1[医药卫生—肿瘤]