三维适形放疗配合同期化疗治疗食管癌根治术后胸内淋巴结复发

doi:10.3971/j.issn.1000-8578.2009.09.018

三维适形放疗配合同期化疗治疗食管癌根治术后胸内淋巴结复发

Three Dimensional Conformal Radiotherapy Combined with Concurrent Chemotherapy for Postoperative Thoracic Lymph Nodes Recurrence of Esophageal Cancer

摘要

摘要: 目的观察三维适形放疗（3-Dimensional Conformal Radiotherapy,3DCRT）加每周顺铂单药同期化疗（Concurrent Chemotherapy，CT）治疗食管癌根治术后胸内淋巴结复发的临床疗效和治疗反应。方法 98例食管鳞癌，根治术后未经放化疗而胸内淋巴结复发，随机分为两组，单纯3DCRT组：全程3DCRT，处方剂量为95%PTV60~70Gy/30~35Fx；3DCRT+CT组：放疗同时采用每周DDP（30mg/m²）单药方案同期化疗，观察两组疗效和治疗反应。结果 3DCRT+CT组近期有效率明显优于3DCRT组(91.8%vs. 73.5%，P=0.016），1、3年生存率也优于3DCRT组(85.7% vs. 69.4%，P=0.032；46.9% vs. 28.6%，P=0.038)，5年总生存率两组差异无统计学意义(14.3%vs. 8.2%，P=0.051)。3DCRT+CT组死于远处转移5例，低于3DCRT组的13例（P=0.036）。3DCRT+CT组急性上消化道和骨髓不良反应较3DCRT组重（P＜0.05），而后期并发症两组没有区别（P＞0.05）。结论采用3DCRT配合同期化疗治疗食管癌根治术后胸内淋巴结复发是一种有效可行的方式，可提高肿瘤局部控制率，降低远处转移率，有提高长期生存率的趋势。

Abstract: Objective To investigate the applications and treatment results of 3-dimensional conformal radiotherapy combined with concurrent cisplatin(DDP) weekly chemotherapy (3DCRT+CT) for postoperative thoracic lymph nodes recurrence (PTLNR)of esophageal cancer. Methods 98 patients with PTLNR of esophageal cancer without adjuvant chemoradiotherapy were randomly devided into 3DCRT alone and 3DCRT+CT groups. 60~70Gy/30~35Fx was delivered to the PTV with whole-range 3DCRT in 2 groups.In addition,those patients of 3DCRT+CT group were dripped cisplatin(DDP) 30mg/m² weekly. Results 3DCRT+CT group showed a better response rate, that was 91.8% vs. 73.5%(P=0.016). Furthermore, the survival rates at 1 and 3 years of 3DCRT+CT were superior to that of 3DCRT alone (85.7% vs. 69.4%，P=0.032；46.9% vs. 28.6%，P=0.038). However,no significant difference in the overall survival rates at 5 years was observed between the two groups (14.3% vs. 8.2%，P=0.051). 5 patients died of distance metastasis in 3DCRT+CT group and 13 patients in 3DCRT (P=0.036). Acute radiation-induced esophagitis and granulocytopenia in 3DCRT+CT group were more frequent (P＜0.05),while there was no significant difference in the late toxicity. Conclusion 3DCRT combined with concurrent chemotherapy is an available and feasible option for PTLNR of esophageal cancer,and can increase the tumor local control rate, decrease the distance metastasis rate and even be advantageous to long-term survival rate.

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