食管癌调强放疗淋巴引流区预防照射的同期对照研究  

The concurrent control study of elective nodal prophylactic irradiation with intensity modulated radiotherapy for esophageal carcinoma

作　　者：祝淑钗[1] 董辉[1] 沈文斌[1] 刘志坤[1] 李娟[1] 苏景伟[1] 

机构地区：[1]河北医科大学第四医院放疗科,石家庄050011

出　　处：《中华放射医学与防护杂志》2014年第10期758-762,共5页Chinese Journal of Radiological Medicine and Protection

基　　金：河北省医学适用技术跟踪项目（GL200848）

摘　　要：目的 探讨应用调强技术进行食管癌根治性放疗患者淋巴引流区预防照射的价值,筛选出淋巴引流区预防照射的适合人群,以进一步提高局部控制,改善长期生存.方法 对根治性放疗的食管癌初治患者进行同期对照研究,完成治疗计划且资料完整可供分析者148例,74例接受选择性淋巴引流区预防照射（ENI）,74例接受累及野照射（IFI）.采用Kaplan-Meier法计算两组患者局部控制率和生存率并进行单因素和多因素预后分析.结果 ENI组与IFI组1、3、5年局部控制率分别为72.5％、52.8％、50.6％和58.4％、35.8％、21.9％（x2=7.881,P＜0.05）.ENI组与IFI组1、3、5年生存率分别为74.3％、44.2％、24.5％和68.9％、27.6％、15.9％（x2=1.903,P＜0.05）.多因素分析发现临床T分期、病变部位、照射方式是影响全组患者局部控制的独立性因素,T分期、N分期、钡餐造影长度和化疗是影响全组患者生存的独立性因素.结论 ENI组的局部控制率较IFI显著提高,早期和胸中段食管癌患者行ENI照射局部控制及生存均能获益.Objective To explore the value of elective nodal prophylactic irradiation with intensity modulated radiotherapy（IMRT） for esophageal carcinoma.Screening patients who are suitable for elective nodal prophylactic irradiation （ENI）,in order to improve locoregional control and overall survival.Methods The concurrent control study was conducted to esophageal cancer patients who were treated by definitive radiotherapy.A total of 148 patients finished treatment were identified.Seventy-four patients received ENI,while the other seventy-four patients received involved-field irradiation （IFI）.Kaplan-Meier method was used for calculation of locoregional control rates and overall survival rates.The univariate and multivariate analysis of prognostic factors were also tested.Results The 1-,3-,and 5-year locoregional control rates of ENI group and IFI group were 72.5%,52.8%,50.6% and 58.4%,35.8%,21.9% （x2 =7.881,P 〈0.05）,respectively.The 1,3,and 5 years survival rates of the ENI group and IFI group were 74.3%,44.2%,24.5% and 68.9%,27.6%,15.9% （x2 =1.903,P 〈 0.05）,respectively.In Cox multivariate analysis,clinical T stage,tumor location,different radiotherapy region were independent factors for the locoregional control of all patients,and clinical T,N stage,the length of esophageal barium meal and chemotherapy were independent factors for the overall survival of all patients.Conclusions Esophageal carcinoma patients treated with ENI could achieve better locoregional control than those treated with IFI.Esophageal carcinoma patients with early stage or middle thoracic lesion could benefit from ENI for local control and overall survival.

关 键 词：食管癌 放射治疗 淋巴引流区预防照射 累及野照射 同期对照 

分 类 号：R735.1[医药卫生—肿瘤] R730.55[医药卫生—临床医学]