食管癌术前放射治疗的前瞻性临床研究  

Randomized trial on combined pre-operative irradiation and surgery in the treatment of esophageal carcinoma-report on 418 patients

作　　者：汪楣[1] 谷铣之[1] 黄国俊[2] 杨宗贻[1] 汪良骏[2] 陈东福[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 [2]中国医学科学院中国协和医科大学肿瘤医院胸外科,北京100021

出　　处：《中华放射肿瘤学杂志》2001年第3期168-172,共5页Chinese Journal of Radiation Oncology

摘　　要：目的　为进一步估价术前放射治疗和外科手术综合治疗食管癌的近远期疗效 ,再次分析随诊满 5年以上的 418例食管癌随机分组临床研究结果。方法　 1977年 6月至 1989年 4月 ,对胸中段食管癌 (按 1978年UICC分段标准 )、长度 8cm以下 (1984年起为 5～ 8cm)、年龄 <6 5岁 ,能进半流、无外科手术禁忌证的病例进行信封法随机分组 :术前放射治疗组 [(R +S) 195例 ],和单纯手术组 [(S) 2 2 3例 ]。放射治疗使用 8MVX射线 ,前后 2个野包括全纵隔及胃左动脉旁淋巴结引流区 ,剂量DT40Gy 2 0次 4周。双锁骨上区未做预防照射 ,间隔 2～ 4周后进行手术。用Kaplan Meier法计算生存率 ,Logrank检验两组的差异性。结果　R +S组和S组手术切除率分别为 90 .3%和 85 .7% (P =0 .0 8) ,术后病理淋巴结转移率分别为 2 2 .2 %和 40 .8% (P <0 .0 1) ,T4 N0 M0 +T4 N1M0 期分别占 2 9.2 %和 5 7.4% (P <0 .0 0 5 ) ;手术死亡率分别为 2 .2 %和 4.2 % ;胸内吻合口瘘发生率分别为 2 .2 %和3 .7% ,食管残端残存癌发生率分别为 0 %和 2 .1% ,局部和区域复发率分别为 2 2 .7%和 41.4% (P <0 .0 1)。R +S组生存率优于S组 (P =0 .0 2 4)。结论　术前放射治疗能降低术后病理淋巴结转移率和缩小肿瘤及明显降期作用 ;能降低局部和区域复发?Objective To validate the results of combined pre operative irradiation and surgery for esophageal carcinoma by a randomized trial on 418 patients treated from June 1977 to April 1989.Methods Patients with lesions ≤8?cm, younger than 65 years, at least on semi liquid diet, and not contra indicated for surgery were randomized into a combined group (R+S, 195 patients) or a surgery alone group (S,223 patients). 8 MV X ray. anterio posterior/posterio anterior(AP/PA) portals encompassing the whole mediastinum and the left gastroepiploic lymphatic chain was used to deliver a dose of 40?Gy. Surgery was carried out after 2 to 4 weeks' rest. Survival curves were calculated using the Kaplan Meier and log rank test.Results The results of the R+S group and S group were : resection rate 90.3% and 85.7% (P=0.08), lymph node metastasis rate 22.2% and 40.8% (P<0.01) and incidence of invasion beyond adventitia 29.2% and 57.4% (P<0.005), operative mortality rate 2.2% and 4.2%, intra thoracic anastomotic leak rate 2.2% and 3.7%, positive esophageal stump rate 0% and 2.1%, respectively. The survival rate of R+S group was higher than that of surgery alone group (P=0.024). The incidences of local recurrence, 22.7% and 41.4% of R+S and S alone groups were quite different (P<0.01).Conclusions Pre operative irradiation followed by surgery gives a significantly beneficial effect on the long term survival and local control. Pre operative irradiation is able to reduce the lymph node metastasis , tumor invasion and increase the resection rate without increasing the surgical mortality or complications.

关 键 词：食管肿瘤 放射治疗 外科手术 综合治疗 预后 

分 类 号：R735.1[医药卫生—肿瘤] R730.5[医药卫生—临床医学]