| CHEN Jun-qiang,CHEN Ming-qiang,LI Yun-ying.Clinical study on the target of prophylactic radiotherapy after three field radical esophagectomy of thoracic esophageal carcinoma[J].Chinese Journal of Radiological Medicine and Protection,2006,26(4):374-377 |
| Clinical study on the target of prophylactic radiotherapy after three field radical esophagectomy of thoracic esophageal carcinoma |
| Received:December 28, 2005 |
| DOI： |
| KeyWords:Esophageal neoplasma Surgery Radiotherapy Radiation field |
| FundProject: |
| Author Name | Affiliation | | CHEN Jun-qiang | The Teaching Hospital of Fujian Medical University, Fujian Provincial Tumor Hospital, Fuzhou 350014, China | | CHEN Ming-qiang | The Teaching Hospital of Fujian Medical University, Fujian Provincial Tumor Hospital, Fuzhou 350014, China | | LI Yun-ying | The Teaching Hospital of Fujian Medical University, Fujian Provincial Tumor Hospital, Fuzhou 350014, China | | 潘建基 | The Teaching Hospital of Fujian Medical University, Fujian Provincial Tumor Hospital, Fuzhou 350014, China | | 吴君心 | The Teaching Hospital of Fujian Medical University, Fujian Provincial Tumor Hospital, Fuzhou 350014, China | | 佘志廉 | The Teaching Hospital of Fujian Medical University, Fujian Provincial Tumor Hospital, Fuzhou 350014, China | | 朱坤寿 | The Teaching Hospital of Fujian Medical University, Fujian Provincial Tumor Hospital, Fuzhou 350014, China | | 柳硕岩 | The Teaching Hospital of Fujian Medical University, Fujian Provincial Tumor Hospital, Fuzhou 350014, China | | 肖锦榕 | The Teaching Hospital of Fujian Medical University, Fujian Provincial Tumor Hospital, Fuzhou 350014, China |
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| Abstract:: |
| 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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