| 李巧芳,祝淑钗,邓文钊,等.颈胸上段食管癌根治性放化疗靶区范围对预后生存的影响[J].中华放射医学与防护杂志,2019,39(4):268-273.Li Qiaofang,Zhu Shuchai,Deng Wenzhao,et al.Clinical outcomes in different target volume for cervical and upper-thoracic esophageal cancer in definitive chemoradiotherapy[J].Chin J Radiol Med Prot,2019,39(4):268-273 |
| 颈胸上段食管癌根治性放化疗靶区范围对预后生存的影响 |
| Clinical outcomes in different target volume for cervical and upper-thoracic esophageal cancer in definitive chemoradiotherapy |
| 投稿时间：2018-09-21 |
| DOI：10.3760/cma.j.issn.0254-5098.2019.04.005 |
| 中文关键词: 颈胸上段食管癌 淋巴引流区预防照射 累及野照射 根治性放化疗 预后 |
| 英文关键词:Esophageal cancer Elective nodal irradiation(ENI) Involved-field irradiation(IFI) Definitive chemoradiotherapy Prognostic factors |
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| 中文摘要: |
| 目的 探讨颈胸上段食管癌根治性放化疗时调强放疗靶区范围对生存预后的影响，并结合失败模式，为颈胸上段食管癌放射治疗靶区勾画提供参考标准。方法 回顾性收集2010年至2014年间在本院接受根治性同期放化疗的132例颈胸上段食管癌患者临床资料，其中选择性淋巴引流区照射（ENI）者71例，累及野照射（IFI）者61例。采用Kaplan-Meier法计算局部控制（LC）、无进展生存（PFS）、总生存（OS），并行Log-rank法检验、COX风险模型单因素及多因素预后分析。结果 随访至2017年12月底，中位随访时间59.5（14.2~95.8）个月，随访率为99.2%。ENI组与IFI组1、3、5年LC分别为77.5%、58.8%、48.8%和64.3%、29.1%、26.2%（χ2=9.68，P=0.002），PFS分别为68.6%、37.7%、25.9%和47.5%、17.2%、3.6%（χ2=11.39，P=0.001），OS分别为81.7%、53.9%、31.3%和70.5%、31.9%、16.3%（χ2=7.70，P=0.006）。多因素分析显示T分期、N分期和照射范围是局部控制、无进展生存和总生存的独立性预后影响因素（P<0.05）。ENI组总失败率和局部区域复发率均明显低于IFI组（χ2=13.23、5.24，P<0.05）。ENI组和IFI组≥ 3级的放射性食管炎、肺炎和骨髓抑制差异均无统计学意义（P>0.05）。结论 颈胸上段食管癌患者接受根治性放化疗时，选择性淋巴引流区照射可明显降低局部区域复发和远处转移，进而改善长期生存。 |
| 英文摘要: |
| Objective To investigate the prognostic effects and failure patterns of different clinical target volumes of IMRT in definitive chemoradiotherapy for cervical and upper-thoracic esophageal cancer, in order to provide a reference for radiotherapy target area delineation. Methods A retrospective analysis was performed on the clinical data of 132 patients with cervical and upper-thoracic esophageal cancer who received definitive IMRT and concurrent chemotherapy in our hospital from 2010 to 2014. Seventy-one patients received elective nodal irradiation (ENI) and the other 61 patients received involved-field irradiation (IFI). The Kaplan-Meier method was used to calculate local control (LC), progression-free survival (PFS) and overall survival (OS) rates. The significant difference was evaluated by the log-rank test. The prognostic factors were determined by Cox univariate and multivariate analyses. Results The last follow-up time was December 2017, the median follow-up time was 59.5 (14.2-95.8) months. Follow-up rate was 99.2%. For the ENI and IFI groups, the 1-, 3-, 5-year LC were 77.5%, 58.8%, 48.8% vs. 64.3%, 29.1%, 26.2% (χ2=9.68, P=0.002), PFS were 68.6%, 37.7%, 25.9% vs. 47.5%, 17.2%, 3.6% (χ2=11.39, P=0.001), OS were 81.7%, 53.9%, 31.3% vs. 70.5%, 31.9%, 16.3% (χ2=7.70, P=0.006), respectively. In multivariate analysis, T stage, N stage, and RT field were independent factors for LC, PFS and OS(P<0.05). The total failure rates, local-regional recurrent rate in ENI group were lower than those in IFI group (χ2=13.23, 5.24, P<0.05). No significant differences were found in acute radiation esophagitis, pneumonitis and myelosuppression (Grades ≥ 3) between the two groups(P>0.05). Conclusions Compared with IFI, ENI can significantly reduce local-regional recurrence and distant metastasis and improve the long-term survival for cervical and upper-thoracic esophageal cancer patients who received definitive chemoradiotherapy. |
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