李博, 章文成, 赵路军, 刘宁波, 庞青松, 袁智勇, 刘维帅, 王平. 食管癌根治术后复发的治疗策略[J]. 中国肿瘤临床, 2013, 40(24): 1553-1557. DOI: 10.3969/j.issn.1000-8179.20131379
引用本文: 李博, 章文成, 赵路军, 刘宁波, 庞青松, 袁智勇, 刘维帅, 王平. 食管癌根治术后复发的治疗策略[J]. 中国肿瘤临床, 2013, 40(24): 1553-1557. DOI: 10.3969/j.issn.1000-8179.20131379
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Bo LI, Wencheng ZHANG, Lujun ZHAO, Ningbo LIU, Qingsong PANG, Zhiyong YUAN, Weishuai LIU, Ping WANG. Therapeutic strategy to prevent the recurrence of esophageal carcinoma after radical resection[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2013, 40(24): 1553-1557. DOI: 10.3969/j.issn.1000-8179.20131379
Citation: Bo LI, Wencheng ZHANG, Lujun ZHAO, Ningbo LIU, Qingsong PANG, Zhiyong YUAN, Weishuai LIU, Ping WANG. Therapeutic strategy to prevent the recurrence of esophageal carcinoma after radical resection[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2013, 40(24): 1553-1557. DOI: 10.3969/j.issn.1000-8179.20131379
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食管癌根治术后复发的治疗策略

Therapeutic strategy to prevent the recurrence of esophageal carcinoma after radical resection

    摘要
  • 摘要:
      目的  探讨食管癌根治性切除术后复发患者的放射治疗策略和预后因素。
      方法  回顾性分析病理确诊为食管癌且经R0切除后出现复发转移的66例患者，肿瘤中位复发时间10.6个月；50例患者局部区域复发，16例患者复发合并远处转移；全组患者中，单纯放疗10例，单纯化疗23例，放化联合治疗33例；联合放化疗组：先行化疗者22例，先行放疗者11例。放疗采用6MV-X线，中位放疗剂量60 Gy。
      结果  全组患者1、2、3年生存率和中位生存时间分别为61.9%、25.9%、16.5%和14.3个月（95% CI=2.4~16.2个月）。三种治疗模式中单纯化疗、单纯放疗和联合放化疗的患者中位生存时间分别为11.4、25.5和14.3个月（P= 0.037）。复发合并远处转移的联合放化疗患者，先行化疗较先行放疗生存有获益（P=0.032）。单因素分析显示患者初治时的肿瘤分段、术式、复发是否合并转移、复发后治疗方式以及复发后是否放疗与患者预后相关（P < 0.05）。多因素分析显示患者初始治疗时的肿瘤分段为影响患者预后的独立因素（P < 0.01）。
      结论  术前食管癌分段或许能提示复发的预后；对于有远处转移的患者，先行化疗后再放疗，对延长生存更有益。

     

    Abstract:
      Objective  To evaluate the radiotherapeutic strategy for the treatment of recurrent esophageal cancer after radical resection and determine relevant prognostic factors.
      Methods  A total of 66 patients with esophageal carcinoma and exhibited recurrence after radical surgery were retrospectively reviewed from Jan 2007 to Jun 2010. The median interval of recurrence from the initial surgery was 10.6 months. Among the 66 patients, 50 suffered from loco-regional recurrences alone, and 16 developed distant metastases in addition to loco-regional recurrences. Among the 66 patients, 10 were treated with radiotherapy after recurrence, 23 were treated with chemotherapy alone, and 33 were treated with radiotherapy combined with chemotherapy. Among the 33 patients, 22 were initially treated with chemotherapy and 11 were initially treated with radiotherapy. The median total dose of the external radiotherapy was 60 Gy with 6 MV X-ray of a linear accelerator.
      Results  The median survival period after recurrence was 14.3 months (95% CI = 12.4~16.2 months). The 1-, 2-, and 3-year survival rates were 61.9%, 25.9%, and 16.5%, respectively. The median survival period after recurrence in the patients who were treated with chemotherapy alone, radiotherapy alone, and radiotherapy combined with chemotherapy were 11.4, 25.5, and 14.3 months, respectively. The patients who developed distant metastases treated with chemotherapy initially showed better survival outcome than those treated with radiotherapy (P = 0.032). Univariate analysis results showed the following prognostic factors: tumor location before surgery; operation mode; whether or not recurrence was detected with distant metastases; and therapy after recurrence. Multivariate analysis results showed that tumor location before surgery was an independent prognostic factor.
      Conclusion  Tumor location may indicate prognosis after recurrence. Patients with recurrent esophageal carcinoma and developed distant metastases treated with chemotherapy may initially benefit from a longer survival rate.

     

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