65～75岁胸段食管鳞癌患者根治术后放疗的临床观察  

Postoperative radiotherapy for patients aged from 65-75 with thoracic esophageal squamous cell carcinoma

作　　者：姜万荣 刘凤 周彬 孙向东 JIANG Wanrong;LIU Feng;ZHOU Bin;SUN Xiangdong(Department of Radiation Oncology,Qinhuai Medical District,Easter Theater General Hospital of PLA,Nanjing 210002,China)

机构地区：[1]东部战区总医院秦淮医疗区放疗科

出　　处：《临床肿瘤学杂志》2020年第1期26-32,共7页Chinese Clinical Oncology

摘　　要：目的回顾性分析65~75岁老年胸段食管鳞癌患者接受根治性切除术后放疗的疗效和安全性。方法收集2004年5月至2018年5月接受根治性手术联合术后放疗的68例老年食管鳞癌患者的临床资料,术后4~6周开始放疗,靶区包括术后瘤床和高危淋巴引流区,总剂量为50~54Gy,其中19例患者接受术后同步放化疗。采用Kaplan-Meier法计算总生存时间(OS)、无病生存时间(DFS)、无局部区域复发生存时间(LRFS)以及无远处转移生存时间(DMFS),影响OS的多因素分析采用Cox比例风险回归模型。结果随访截止于2018年5月15日,随访率为98.5%,中位随访27.7个月。全组1、3、5年生存率分别为87.9%、65.2%和50.4%,中位OS为61.2个月;中位DFS为48.8个月,1、3、5年无病生存率分别为85.1%、55.8%和37.2%;中位LRFS为54.4个月,1、3、5年无局部区域复发生存率分别为81.6%、60.4%和47.8%;中位DMFS为60.5个月,1、3、5年无远处转移生存率分别为84.8%、62.4%和50.2%。单因素分析显示,T分期、淋巴结转移、淋巴结转移数量和TNM分期与OS有关(P<0.05);多因素分析显示,TNM分期(HR=3.626, 95%CI:1.610~8.167,P=0.002)是影响OS的独立因素。全组常见不良反应为放射性肺炎、骨髓抑制、黏膜反应、疲劳、出血和吻合口狭窄,以1~2级为主,3级不良反应10例。全组死亡40例,肿瘤原因死亡22例,非肿瘤原因死亡15例,另外3例死因不详。结论可耐受手术的老年(65~75岁)胸段食管鳞癌患者进行术后放疗可延长OS,不良反应可耐受,TNM分期是影响OS的独立因素。Objective To retrospectively analyze the efficacy and safety of postoperative radiotherapy for patients with thoracic esophageal squamous cell carcinoma(TESCC)aged from 65 to 75 years.Methods The clinical data of 68 patients with TESCC who underwent esophagectomy and postoperative radiotherapy from May 2004 to May 2018 were analyzed.Radiatiotherapy was started 4 to 6 weeks after surgery.The target volume included postoperative tumor bed and high-risk lymphatic drainage area.The total dose was 50-54 Gy.Among them,19 patients underwent concurrent chemoradiotherapy.The Kaplan-Meier method was used to calculate overall survival(OS),disease-free survival(DFS),local recurrence-free survival(LRFS),and distant metastasis-free survival(DMFS).Multivariate analysis was conducted using Cox proportional hazards model.Results Until 15 May 2018,the follow-up rate was 98.5%,and the median follow-up time was 27.7 months.The 1-,3-,and 5-year overall survival rates were 87.9%,65.2%and 50.4%,respectively,and the median OS was 61.2 months.The median DFS was 48.8 months,and the 1-,3-,and 5-year disease-free survival rates were 85.1%,55.8%and 37.2%.The median LRFS was 54.4 months,and the 1-,3-,and 5-year local recurrence-free survival rates were 81.6%,60.4%and 47.8%.The median DMFS was 60.5 months,and the 1-,3-,and 5-year distant metastasis-free survival rates were 84.8%,62.4%and 50.2%.T staging,lymph node metastasis,number of lymph node metastasis and TNM staging were related to OS(P<0.05).TNM staging(HR=3.626,95%CI:1.610-8.167,P=0.002)was the independent factor influencing OS by Cox multivariate analysis.The common toxicities were digestive tract reaction,myelosuppression,mucosal response,fatigue,hemorrhage and anastomotic stenosis,mainly in grade 1-2.Grade 3 toxicities were found in 10 patients.Conclusion postoperative radiotherapy for TESCC patients aged from 65-75 years who can tolerate surgery is safe and able to prolong OS.TNM staging is a major factor that affects OS.

关 键 词：食管鳞癌 放射治疗 老年 术后 

分 类 号：R735.1[医药卫生—肿瘤]