| 陈俊强,陈明强,李云英,等.胸段食管癌三野根治术后放疗靶区的临床研究[J].中华放射医学与防护杂志,2006,26(4):374-377.CHEN Jun-qiang,CHEN Ming-qiang,LI Yun-ying,et al.Clinical study on the target of prophylactic radiotherapy after three field radical esophagectomy of thoracic esophageal carcinoma[J].Chin J Radiol Med Prot,2006,26(4):374-377 |
| 胸段食管癌三野根治术后放疗靶区的临床研究 |
| Clinical study on the target of prophylactic radiotherapy after three field radical esophagectomy of thoracic esophageal carcinoma |
| 投稿时间：2005-12-28 |
| DOI： |
| 中文关键词: 食管肿瘤 外科学 放射疗法 照射野 |
| 英文关键词:Esophageal neoplasma Surgery Radiotherapy Radiation field |
| 基金项目: |
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| 摘要点击次数: 4226 |
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| 中文摘要: |
| 目的 探讨胸段食管癌三野根治术后患者进行预防性放疗不同照射野范围的毒副作用及其对预后的影响。方法 选择我院行颈、胸、腹三野联合根治术的胸段食管鳞癌患者213例。用配对法分为3组:术后放疗“T”型大野组70例,术后放疗“T”型小野组70例和单纯手术组73例。“T”型大野组照射野的范围包括双锁骨上区、纵隔、贲门旁胃左动脉淋巴结引流区、吻合口及原食管瘤床。“T”型小野组照射野的范围包括双锁骨上区、中上纵隔淋巴结引流区、吻合口及原食管瘤床。于术后3～4周开始放疗,中位总剂量54Gy,分27次,每次2Gy,5次/周,5.4周完成。结果 术后放疗大野组恶心、食欲不振、胸腔胃溃疡出血及非癌性心包胸腔积液的毒副作用明显重于小野组,大野组有6例死于非癌性心包胸腔积液,3例死于胸腔胃溃疡出血;小野组仅1例死于胸腔胃溃疡出血,两组比较差异有统计学意义(P<0.05)。术后有淋巴结转移者放疗大野组、小野组和手术组5年生存率分别为36.8%、43.9%、23.6%(P<0.05);而无淋巴结转移者分别为54.7%、68.9%、47.3%(P>0.05);3组区域淋巴结转移复发率分别为15.7%、15.7%、41.1%,大小野组比较差异无统计学意义(P>0.05),但与手术组比较差异有统计学意义(P<0.05);3组血行转移率分别为22.9%、17.1%、19.2%(P>0.05)。结论 食管癌术后放疗小野照射可提高局部控制率及生存率,而且毒副作用轻,患者能够耐受。建议胸段食管癌三野根治术后预防性照射靶区包括双锁骨上区、中上纵隔淋巴结引流区及原食管瘤床。 |
| 英文摘要: |
| Objective To investigate the toxicities and the impact on prognosis of radiotherapy after radical esophagectomy with three field lymphadenectomy esophagectomy(cervical,mediastinal,abdominal) for esophageal carcinoma with different radiation fields size. Methods 213 patients of esophageal squamous cell carcinoma were accrued after radical esophagectomy with three field lymphadenectomy.All patients were devided into 3 groups using case-match methods:the “T”-shape extended field group(TE) with 70 cases, the “T”-shape regional field group(TR) with 70 cases and surgery alone group(SA) with 73 cases.The radiation fields for TE group included bilateral supraclavicular region,total mediastinum,lymph nodes of left gastric artery,anastomotic site and primary tumor bed;While the TR field included bilateral supraclavicular region,upper and middle mediastinum,anastomotic site and primary tumor bed. Radiation treatment started 3-4 weeks after operation. Median total dose was 54 Gy in 27 fractions,5 daily fractions of 2 Gy per week in 5.4 weeks. Results Incidences of nausea, anepithemia, non-carcinous hydropericardium and hydrothorax were more severe in TE than that in TR.6 patients died of non-carcinous hydropericardium and hydrothorax, 3 patients died of hemorrhage of thoracic-gastric ulcer in TE group, however 1 patient died of hemorrhage of thoracic-gastric ulcer in TR group.The differnce between two groups was statistically significant (P<0.05). The 5-year survival rate with and without lymph node metastases in TE,TR and SA groups were 36.8%,43.9%,23.6%(P<0.05) and 54.7%,68.9%,47.3%(P>0.05), respectively. Relapse rate of regional lymph nodes in the three groups were 15.7%,15.7% and 41.1%,respectively. The local control rate in TE and TR had no statistical difference (P>0.05), while difference between radiation group(TE,TR) and SA was statistically significant. Distant metastases rates in the three groups were 22.9%,17.1% and 19.2%(P>0.05),respectively. Conclusion Postoperative radiotherapy with the regional field could increase local control and survival rate,but the side effect was slight. We suggest the prophylactic radiation after 3-field radical esophagectomy for thoracic esophageal squamous cell carcinoma should only include bilateral supraclavicular region,upper and middle mediastinum lymph node region and primary tumor bed. |
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