天津医药

天津医药 ›› 2018, Vol. 46 ›› Issue (2): 161-165.doi: 10.11958/20171072

• 临床研究 • 上一篇    下一篇

选择性淋巴结区域照射和累及野照射治疗胸段食管癌患者的临床观察

阿不力克木江 ·阿地力1 ， 王海峰1 ， 伊斯刊达尔 ·阿布力米提1△， 霍东杰1 ， 张玲1 ， 祖木来提 ·库尔班2   

  1. 1 新疆医科大学附属肿瘤医院胸腹放疗科 （邮编830011）； 2 新疆医科大学第一附属医院
  • 收稿日期:2017-10-11 修回日期:2018-01-05 出版日期:2018-02-15 发布日期:2018-02-15
  • 通讯作者: 伊斯刊达尔·阿布力米提 E-mail:iskandara@126.com

Clinical observation on the thoracic esophageal cancer patients treated with elective nodal irradiation and involved field irradiation

Abulikemujiang·ADILI 1 , WANG Hai-feng1 , Yisikandaer·ABULIMITI 1△, HUO Dong-jie1 , ZHANG Ling1 ， Zumulaiti·KUERBAN2   

  1. 1 Radiotherapy Department of Chest and Abdomen, the Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, China; 2 the First Affiliated Hospital of Xinjiang Medical University
  • Received:2017-10-11 Revised:2018-01-05 Published:2018-02-15 Online:2018-02-15

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摘要： 摘要： 目的 研究选择性淋巴结区域照射 （ENI） 和累及野照射 （IFI） 在根治性放射治疗胸段食管鳞癌中的疗效、失败模式及不良反应， 探讨合理的靶区勾画方法。方法 采用前瞻性、 随机、 对照设计， 选取 2012 年 11 月—2016 年 2 月我院收治的 86 例胸段食管鳞癌患者， 随机进入 ENI 组 （39 例） 和 IFI 组 （47 例）， 患者均接受同步放化疗， ENI 组在 IFI 组的基础上对高危淋巴引流区进行预防照射。治疗结束后对所有患者进行 3~33 个月的随访， 中位随访时间 15 个月。计算 2 组的近期有效率 （治疗后 3 个月）， 1 年生存率、 无进展生存率和局部控制率， Kaplan-Meier 法绘制生存曲线， Log-rank 法比较生存率差异， 同时分析 2 组的治疗失败模式及不良反应发生情况。结果 ENI 组和 IFI 组的近期有效率比较差异无统计学意义 （92.3% vs. 95.7%， χ2 =0.460， P＞0.05）。2 组 1 年生存率分别为 66.7% 和 68.1%， 1 年无进展生存率为 56.4% 和 53.2%， 1 年局部控制率为 92.3% 和 87.5%， 差异均无统计学意义 （P＞0.05）。随访结束时 ENI 组和 IFI 组的中位生存时间均为 15 个月， 生存率比较差异无统计学意义 （Log-rank χ2 =1.520， P= 0.218）。全部 86 例患者中共有 35 例治疗失败， 其中 ENI 组 17 例， IFI 组 18 例。ENI 组和 IFI 组区域失败率为 35.9% 和 27.7%， 远处转移率为 20.5% 和 14.9%， 放射野内失败率为 30.8% 和 23.4%， 放射野外失败率为 4.3% 和 5.1%， 差异均无统计学意义 （P＞0.05）。不良反应方面， 2 组骨髓抑制、 消化道反应、 放射性肺损伤、 放射性食管损伤的发生率比较差异无统计学意义 （P＞0.05）。结论 胸段食管鳞癌行根治性放疗时， ENI 在近期疗效、 失败模式、 不良反应及预后等方面与IFI 相似， 为了尽可能减少正常组织的受照剂量， 建议选择照射范围较小的IFI 治疗。

关键词: 关键词： 食管肿瘤, 放射疗法, 累及野照射, 选择性淋巴结区域照射, 失败模式

Abstract: Abstract：Objective To observe the curative effect, failure pattern and treatment-related toxicities of elective nodal irradiation (ENI) and involved field irradiation (IFI) in patients with thoracic esophageal squamous cell carcinoma treated with radical radiotherapy, and determine the reasonable target delineation of radiotherapy. Methods Using prospective randomized controlled design, a total of 86 patients with thoracic esophageal squamous cell carcinoma were randomly allocated to two groups: ENI group (n=39) and IFI group (n=47). Both groups received concurrent chemoradiotherapy. In ENI group, the high-risk lymphatic drainage area received prophylactic irradiation on the basis of IFI group. After the treatment, all patients were followed up for 3~33 months. The median follow-up period was 15 months. The short-term effective rate, one year survival rate, progression free survival rate and the local control rate of two groups were calculated. The survival curve was drawn by the Kaplan-Meier method, and the survival rate was compared using the Log-rank method. Meanwhile, the treatment failure pattern and incidence of adverse reactions were analyzed in the two groups. Results There was no significant difference in effective rate between ENI group and IFI group (92.3% vs. 95.7%， χ2 =0.460, P＞0.05). The one- year survival rates were 66.7% and 68.1% for the two groups, respectively. The progression-free survival rates were 56.4% and 53.2% respectively. The local control rates were 92.3% and 87.5% respectively, with no statistical difference (P＞0.05). The median survival time was 15 months at the end of the follow-up for group ENI and group IFI, and there was no significant difference in survival rate between two groups (Log-rank χ2 =1.520， P=0.218). There were 35 cases with treatment failure in all 86 patients, of which 17 cases were in group ENI and 18 cases in group IFI. The regional failure rates were 35.9% and 27.7% in ENI and IFI groups respectively, distant metastasis rates were 20.5% and 14.9% respectively, in-field failure rates were 30.8% and 23.4% respectively, and out-of-field failure rates were 4.3% and 5.1% respectively, which showed no significant differences (P＞0.05). There were no significant differences in side effects, the incidence of bone marrow suppression, gastrointestinal reactions, radiation esophagitis and radiation-induced lung injury between two groups (P＞0.05). Conclusion ENI shows similar recent efficacy, failure patterns, adverse reactions and prognosis with IFI for thoracic esophageal squamous cell carcinoma patients receiving radical radiotherapy. So IFI treatment is recommended to minimize the exposure dosage of normal tissue.

Key words: Key words: esophageal neoplasms, radiotherapy, elective nodal irradiation, involved field irradiation, patterns of failure