中胸段食管癌累及野与淋巴结选择性照射对比研究  

Comparation of involved-field conformal irradiation and elective nodal irradiation for middle-thoracic esophageal cancer

作　　者：臧茹琨[1] 马金波[1] 宋轶鹏[1] 王大卫[1] 刘鹏[1] 

机构地区：[1]青岛大学医学院附属烟台毓璜顶医院放疗科,山东烟台264000

出　　处：《中华肿瘤防治杂志》2013年第24期1917-1920,共4页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的:通过对中胸段食管癌累及野与淋巴结选择性照射的临床研究,为中胸段食管癌放疗方式选择提供参考依据。方法:选择2003-03-28-2007-04-02青岛大学医学院附属烟台毓璜顶医院接受同期化放疗的食管癌患者73例,采用抽签法随机分为累及野照射组(involved-field irradiation,IFI)和局部淋巴结选择性照射组(elective nodal irradiation,ENI)。随访观察两组患者的治疗毒副作用、失败情况、局部控制率和生存率。结果:IFI组>Ⅲ级急性毒副作用发生率为14.3%(5/35),明显低于ENI组的42.1%(16/38),χ2=10.531,P=0.001。IFI和ENI组的局部区域失败率分别为47.8%(11/23)和57.9%(11/19),远处转移率分别为21.7%(5/23)和15.8%(3/19),为失败的主要形式;野内复发率分别为43.5%(10/23)和43.4%(9/19),为局部区域失败的主要方式。野外复发少见,分别为4.3%(1/23)和10.5%(2/19)。IFI组患者1、2和3年总生存率分别为71.8%、44.7%和25.7%,ENI组分别为66.1%、60.0%和45.4%,两组差异无统计学意义,r=0.586,P=0.444;IFI组1、2和3年局部控制率分别为93.0%、71.6%和71.5%,ENI组分别为87.0%、80.0%和80.0%,两组差异无统计学意义,r=0.281,P=0.596。T分期是重要的预后因素,χ2=0.521,P=0.045。结论:与淋巴结选择性照射相比,中胸段食管癌累及野照射可减少治疗毒副作用,而不降低肿瘤局部控制率及患者生存率。OBJECTIVE：To compare the involved-field irradiation （IFI） and elective nodal irradiation （END tech niques for middle-thoracic esophageal cancer in order to find the more effective radiotherapy method. METHODS： From 2003-03 28 to 2007-04-02 Yantai Yuhuangding Hospital, Medical College, totally 73 eligible patients were treated with concurrent chemoradiation and randomized into either an IFI or ENI group. Patients were followed for treatment related toxicities,patterns of failure,local control rate and overall survival rate. RESULTS： Grade 3 or higher acute toxicity was statistically lower in the lFI [14. 3%（5/35）] than that of ENI group [-42.1% （16/38） ./2=10.531,P=0.001];Thedom_ inate patterns of failure were local/regional [47. 8% （11/23） and 57. 9% （11/19）] failure and distant failure E21. 7%（5/23） and 15.8% （3/19）2, and the main pattern of local/regional failure was in field lymph failure [43.5 % （10/23） and 43.4%（9/19）],out-field lymph failure [4.3%（1/23） and 10.5%（2/19）] was rare. Three years local control rate and o verall survival rate didn＇t reach a statistical difference in the IFI versus ENI group in this study, which were 71. 8%, 44.7%,25.7% vs 66. l%,60.0%,45.4%（r=0.586,P=0.444）and 93.0%,71. 6%,71. 5% vs 87.0%,80.0%,80.0% （r= 0. 281,P=0. 596）,respectively. Tumor stage was significant prognostic factor （x2=-0. 521,P=0. 045）. CONCLU- SION： Compared to ENI,IFI is an acceptable and toxicity-minimizing method of treatment for midd[e-thoracic esophageal cancer,and does not cause significant failure in lymph node regions.

关 键 词：食管肿瘤 放射疗法 放疗靶区 淋巴结转移 累及野照射 淋巴结选择性照射 

分 类 号：R735.1[医药卫生—肿瘤]