食管癌术前放疗后的治疗方法探讨  

The optimum treatment for the patients with unoperable advanced esophageal cancer after pre operative radiotherapy.

作　　者：刘海龙[1] 邱荣良[1] 沙永慧[1] 

机构地区：[1]河南省肿瘤医院放疗科,郑州450003

出　　处：《中国肿瘤临床与康复》2000年第5期51-53,共3页Chinese Journal of Clinical Oncology and Rehabilitation

摘　　要：目的　探讨手术困难的食管癌行术前剂量放疗后是否都需要手术。方法　经病理证实的 114例直接手术困难的食管癌接受术前常规分割放疗再手术 (简称术前组 ) ,选用同时期条件相近的 114例接受单纯放疗者作对照 (简称单放组 )。两组均对穿野照射肿瘤区DT40Gy/4周 ,病变在胸上段者加双锁骨区预防照射DT45～ 5 0Gy/4～ 5周。单放组加量至DT6 0～ 6 8Gy/6～ 7周 ,术前组休息 2～ 3周手术。 结果　 1、3、5年生存率 ,术前组和单放组分别为 79.4%、46 .3 %、2 9.4%和 6 2 .4%、34.3 %、17.6 % ;术前放疗后X线示疗效Ⅰ、Ⅱ级者 ,两组生存相近 ;Ⅲ、Ⅳ级者 ,术前组的生存率明显优于单放组。Cox模型多因素分析影响预后因素。术前组局部复发明显减少 (P <0 .0 5 )。结论　手术困难的食管癌术前放疗后X线疗效示Ⅰ、Ⅱ级者 ,可以不手术而继续放疗至根治量 ;Ⅲ、Ⅳ级者则应尽可能争取手术。Objective To analyse if the operation should be given or not for the patients with unoperable advanced esophageal cancer after pre operative radiotherapy.Methods From March 1989 to November 1994,114 cases with unoperable advanced esophageal cancer were treated by combined pre operative radiotherapy and surgery(R+S).Another 114 cases were purely treated by radical radiotherapy (RT).A dose of D T 40Gy/4 weeks was given by PA AP fields,then the R+S group received surgery in 2～3 weeks and the RT group increased the dose to 60～68Gy/6～7 weeks by the back obique angle irradiation fields.Results The 1 ,3 ,5 year survival rate of the R+S group and RT group were 79.4%,46.3%,29.4% and 62.4%,34.3%,17.6%,respectively (log rank test,x 2=4.50,P=0.034).The 1 ,3 ,5 year survival rate of the R+S group and RT group ,for the X ray photography grade Ⅰ were 100%,72.7%,52% and 92.7%,74%,respectively(x 2=0.10,P=0.752),for grade Ⅱ were 85.2%,51.9%,35.1% ane 82.4%,52.4%,32.7%,respectively(x 2=0.22,P=0.64),for grade Ⅲ were 77.7%,44.1%,26.8% and 53%,31.4%,16.8%,respectively(x 2=4.78,P=0.029),for grade Ⅳ were 60%,26.7%,17.8% and 32%,16.3%,4.3%,respectively(x 2=4.33,P=0.038).Conclusions patients with unoperable advanced esophageal cancer after pre operative radiotherapy,whose the X ray assesement showed grade Ⅰ and Ⅱ,should be treated by radical radiotherapy;whose X ray assesement showed grade Ⅲ and Ⅳ should undergo operation. [

关 键 词：食管肿瘤 术前常规分割放疗 放疗 治疗 

分 类 号：R735.1[医药卫生—肿瘤]