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目的分析胸段食管癌放射治疗的疗效、放射治疗反应及预后因素。方法 129例初治食管癌患者,其中常规放疗(CF)组69例,三维适形放疗(3DCRT)组60例。CF组2.0 Gy/次,5次/w,总剂量50～66 Gy;3DCRT组先常规放疗20 Cy,方法同CF组,然后改用3DCRT,2.0 Gy/次,5次/w,总剂量50～70 Gy;用Logrank进行单因素,Cox进行多因素分析。结果 CF组和3DCRT组的有效率(完全缓解+部分缓解)分别为88.4%、93.3%,两组差异有统计学意义(χ2=7.320,P=0.026)。两组患者的放射性食管炎、白细胞减少和晚期并发症无差异(χ2=0.278、1.001、0.486,P>0.05)。3DCRT组1、3、5、7年局部控制率分别为78.3%、67.4%、63.0%、56.5%,CF组分别为64.9%、45.6%、38.6%、36.8%,两组差异有统计学意义(χ2=5.615,P<0.05)。3DCRT组和CF组的1,3,5,7年生存率分别为78.3%、56.5%、39.1%、17.2%和59.6%、31.6%、21.1%、6.1%,两组差异有统计学意义(P<0.05)。单因素分析显示临床分期、疗前饮食状况、病变长度、照射剂量及是否采用3DCRT对生存期有影响。其中临床分期和疗前进食状况这两个因素对预后产生一定的影响。结论 3DCRT具有明显改善食管癌近期缓解率的作用,另外还能明显改善食管癌患者的局部控制率以及生存率,近期放射反应及晚期放射损伤这两者均可耐受。预后的影响因素主要是临床分析和疗前饮食。
Objective To analyze the therapeutic effect of radiotherapy on thoracic esophageal cancer, radiotherapy response and prognostic factors. Methods 129 cases of newly diagnosed esophageal cancer patients, including 69 cases of conventional radiotherapy (CF) group, three-dimensional conformal radiation therapy (3DCRT) group of 60 cases. CF group 2.0 Gy / times, 5 times / w, the total dose of 50 ~ 66 Gy; 3DCRT group conventional radiotherapy 20 Cy, the same method CF group, and then use 3DCRT, 2.0 Gy / times, ~ 70 Gy; single factor with Logrank and Cox with multivariate analysis. Results The effective rate (complete remission + partial remission) in CF group and 3DCRT group was 88.4% and 93.3%, respectively. There was significant difference between the two groups (χ2 = 7.320, P = 0.026). There was no difference in radiation esophagitis, leukopenia and advanced complications between the two groups (χ2 = 0.278,1.001,0.486, P> 0.05). The local control rates in 3DCRT group at 1, 3, 5 and 7 years were 78.3%, 67.4%, 63.0% and 56.5%, respectively, and those in CF group were 64.9%, 45.6%, 38.6% and 36.8% (χ2 = 5.615, P <0.05). The 1, 3, 5, 7-year survival rates of 3DCRT group and CF group were 78.3%, 56.5%, 39.1%, 17.2% and 59.6%, 31.6%, 21.1% and 6.1% respectively, with significant difference between the two groups P <0.05). Univariate analysis showed that clinical stage, pre-treatment diet, length of lesion, irradiation dose and the use of 3DCRT had an impact on survival. The clinical stage and pre-treatment eating status of these two factors have a certain impact on the prognosis. Conclusions 3DCRT can significantly improve the recent remission rate of esophageal cancer, and can significantly improve the local control rate and survival rate of esophageal cancer patients. Both the recent radiation response and the late radiation injury can be tolerated. The main prognostic factors are clinical analysis and pre-treatment diet.