食管癌根治术后预防性放射治疗的临床价值  

Clinical value of prophylactic radiotherapy after curative resection of esophageal carcinoma

作　　者：肖泽芬[1] 杨宗贻[1] 梁军[1] 苗延浚[1] 汪楣[1] 殷蔚伯[1] 谷铣之[1] 张德超[2] 张汝刚[2] 汪良骏[2] 

机构地区：[1]中国医学科学院中国协和医科大学肿瘤研究所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研究所肿瘤医院胸外科,北京100021

出　　处：《中华肿瘤杂志》2002年第6期608-611,共4页Chinese Journal of Oncology

摘　　要：目的　分析食管癌根治术后预防性放射治疗的临床价值。方法　 4 95例食管癌根治性手术切除后 ,随机分为单一手术组 (2 75例 )和术后放疗组 (2 2 0例 )。术后 3～ 4周开始放射治疗。双锁骨上区为 5周 5 0Gy,2 5次 ;全纵隔为 5～ 6周 5 0～ 6 0Gy ,2 5～ 30次。结果　全组 5年生存率为39 .4 %。单一手术组和术后放疗组的 5年生存率差异无显著性 (P =0 .4 4 74 )。单一手术组和术后放疗组的Ⅲ期患者 ,其 5年生存率分别为 13.1%和 35 .1% (P =0 .0 0 2 7)。术后放疗组的胸内淋巴结、锁骨上淋巴结转移率和吻合口复发率分别为 16 .2 %、3.1%和 0 .5 % ,单一手术组分别为 2 5 .9%、13.2 %和 5 .8% (P <0 .0 5 )。吻合口狭窄的发生率单一手术组为 1.8% ,术后放疗组为 4 .1% (P >0 .0 5 )。结论　术后预防性放疗可提高Ⅲ期食管癌根治术后的生存率 ,降低放疗部位淋巴结转移率和吻合口的复发率 ;术后放疗不增加吻合口狭窄等并发症。Objective To evaluate the clinical value of prophylactic radiotherapy for esophageal carcinoma after curative operation. Methods 495 esophageal squamous cell cancer patients who had undergone radical resection were randomized by the envelope method into a surgery alone group (S, 275) and a surgery plus radiotherapy group (S+R, 220). Radiation treatment was started 3-4 weeks after operation. The portals encompassed the whole mediastinum and bilateral supraclavicular areas. A mid-plane dose of 50 ～60 Gy in 20～30 fractions over 5～6 weeks was delivered. Results 1. Survival rate: the overall 5-year survival rate was 39.4%. Those of S alone and S+R groups were 37.1% and 41.3% (P=0.447 4). The 5-year survival rate for Stage Ⅲ patients were 13.1% in S alone group and 35.1% in R+S group (P=0.002 7), 2. Pattern of failure: The incidence of local recurrence intra-thoracic lymph node metastasis, anastomotic recurrence and extra-thoracic lymph node metastasis in S+R group (16.2%, 0.5% and 3.1%) were lower than those (25.9%, 5.8% and 13.2%)(P<0.05) in S alone group and 3. Complictions: the anastomotic stricture frequencies were similar in the two groups (S 1.8%; S+R 4.1%). Conclusion 1. Prophylactic radiotherapy is able to improve the survival rate of stage Ⅲ patients treated by radical resection, 2. Postoperative radiotherapy is able to reduce the incidence of failure by recurrence in the intra-thoracic lymph nodes and anastomotic recurrence to where radiation therapy had been given, 3. Postoperative radiotherapy does not increase the incidence of anastomotic stricture.

关 键 词：食管癌根治术 食管肿瘤 术后放射疗法 食管癌 

分 类 号：R735.1[医药卫生—肿瘤]