摘要:
目的：探讨食管癌术后区域性淋巴结转移患者三维适形放射治疗的预后，并分析影响预后的相关因素。方法：回顾性分析河北医科大学第四医院放疗科2001年1 月至2005年12月收治的食管癌根治术后因区域性淋巴结复发和/或转移而接受根治性三维适形放疗的患者90例，其中79例全程适形放疗处方剂量为50~72Gy/25~36次，11例后程适形放疗的剂量为50~76Gy/25~38次。结果：自手术之日起计算的术后1、3、5 年生存率分别为85.71% 、34.34% 、14.92% ，自复发和（或）淋巴结转移放疗之日起计算的放疗后1、2、3 年生存率分别为43.41% 、18.09% 、7.81% 。单因素分析显示术中测量原发食管病变长度、钡餐造影病变长度、T分期、TNM分期、转移淋巴结个数、淋巴结转移度、术后出现区域性淋巴结转移的时间对术后生存均有显著影响。多因素分析显示双肺V35、放疗后近期疗效和淋巴结缩小率是影响食管癌术后区域性淋巴结转移放疗疗效的独立性预后因素。结论：双肺V35越小、放疗后近期疗效越好；淋巴结缩小率越大，食管癌术后区域性淋巴结复发和（或）转移者放疗后的生存率越高。
关键词:
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食管癌
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放射治疗
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淋巴结
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转移
Abstract:
Objective: To investigate the prognostic factors of three-dimensional conformal radiotherapy (3D-CRT) for regional metastatic lymph nodes of esophageal carcinoma patients treated with surgery.Methods:A total of 90patients with pathology-confirmed esophageal carcinoma by resection specimens, who received radical 3D-CRT due to recurrence and/or lymph nodes metastasis were enrolled. The prescription dose of those79patients who received whole range 3D-CRT was 50~72Gy/25~36F. The other 11cases received conventional radiotherapy before 3D-CRT, and the total dose was 50~ 76Gy/25~38F. Results: The 1-, 3-, and 5-year survival rate after resection were 85.71%,34.34%, and14.92%, respectively. The 1-, 2-, and 3-year survival rates were 43.41% ，18.09%, and7.81%, respectively, after treatment by3D-CRT due to re-currence and/or lymph node metastasis. Primary tumor length, X-ray visualization length, tumor stage, number of metastat-ic lymph nodes, lymph node metastasis time and lymph node ratio (LNR) were significantly associated with long-term sur -vival after resection. TNM stage, maximum diameter and diminution extent of metastatic lymph nodes, occurring metastasis time, early efficacy of radiotherapy and the presence of irradiation induced pneumonia were significantly associated with survival rate after radiotherapy. Conclusion:A direct correlation was seen between lower lung capacity (V 35) and earlier pre-sentation of efficacy after radiotherapy. Also, the extent of diminution of metastatic lymph node was directly correlated with increased survival rate after radiotherapy.
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