食管鳞癌右胸径路开放术后治疗失败模式与放疗价值评估  

Evaluation of the value of postoperative radiotherapy for esophageal squamous cell carcinoma based on the patterns of failure after right thoracotomy

作　　者：刘琳梦 梁健[2] 韩春[1] 王琪 王澜[1] Liu Linmeng;Liang Jian;Han Chun;Wang Qi;Wang Lan(Department of Radiation Oncology,the Fourth Hospital of Hebei Medical University,Shijiazhuang 050011,China;Medical Department,Hebei Chest Hospital,Shijiazhuang 050041,China)

机构地区：[1]河北医科大学第四医院放疗科,石家庄050011 [2]河北省胸科医院医务科,石家庄050041

出　　处：《中华放射肿瘤学杂志》2022年第12期1168-1173,共6页Chinese Journal of Radiation Oncology

基　　金：河北省卫生健康委科研基金项目(重点科技研究计划)(20210249);河北省适用医学跟踪项目(GZ2021036)。

摘　　要：中国当前对于食管癌术后放疗的推荐主要基于左胸径路不完全两野清扫研究数据(2B类证据)。而食管癌外科正处于术式变革期, 已逐步由左开胸向右开胸过渡, 由开放手术向微创手术过渡。右胸径路完全两野/颈胸腹三野清扫相较于左胸径路不完全两野清扫, 可以更彻底地清扫上纵隔和颈部淋巴结, 因而理论上具有更低的区域淋巴结复发率并延长生存期。但对于在新的技术条件下食管癌术后肿瘤复发模式及复发率相较于以往是否会发生明显变化, 术后放疗是否仍具有局部控制和生存获益价值, 术后放疗的适应证是否需要进行相应调整等问题尚未有定论。本文就当前阶段食管癌外科手术术式的变革、右胸径路开放手术的生存状况及其术后的失败模型进行了归纳和总结, 以期评估在右胸径路开放手术条件下辅助放疗的价值。The current recommendation for postoperative radiotherapy for esophageal cancer in China is mainly based on the data of incomplete two‐field dissection of the left thoracotomy(category 2B evidence).However,the surgery of esophageal cancer is undergoing a period of transformation,which has gradually transitioned from left thoracotomy to right thoracotomy,and from open surgery to minimally invasive surgery.Compared with incomplete two‐field dissection of left thoracotomy,complete two‐field/cervical thoracic and abdominal three‐field dissection of right thoracotomy could more thoroughly dissect the upper mediastinum and cervical lymph nodes.Hence,theoretically,it yields a lower recurrence rate of regional lymph nodes and prolongs the survival time.However,under the new technical conditions,whether the tumor recurrence pattern and recurrence rate after esophageal cancer surgery will change significantly compared with the past,whether postoperative radiotherapy still has the value of local control and survival benefits,and whether the indications of postoperative radiotherapy need to be adjusted accordingly have not been determined.Based on the above considerations,the changes in surgical methods for esophageal cancer at the current stage,the survival status of right thoracotomy and postoperative patterns of failure were summarized,aiming to evaluate the value of adjuvant radiotherapy under the condition of right thoracotomy.

关 键 词：食管肿瘤 右胸径路 手术 复发模式 术后放射疗法 

分 类 号：R735.1[医药卫生—肿瘤]