根治性放疗后局部复发的食管癌再程放疗的回顾性研究

发布时间：2018-05-21 02:16

本文选题：食管癌 + 根治性放疗　；参考：《山东大学》2015年硕士论文

【摘要】：研究背景根治性放疗或放化疗现已是被广泛认可的未手术食管癌的主要治疗方案,然而根治性放疗后的多数病人在1-2年内出现复发或转移,局部复发依然是根治性放疗失败的主要类型。根治性放疗后局部复发的食管癌患者,治疗方案的选择较为局限,主要是手术治疗或者姑息性化疗,一些头颈部恶性肿瘤的再程放疗被证实是有效的,而关于食管癌再程放疗的文献资料较少,对根治性放疗后复发的患者再次采用放射治疗的可行性和有效性仍存争议。目的观察研究食管癌根治性放疗后局部复发的患者行再程放疗的近期疗效、不良反应以及复发后生存期,分析影响患者复发后生存预后的各种因素,综合评价食管癌再程放疗的可行性和临床价值。方法回顾性收集根治性放疗或放化疗后CR或PR、并在首次治疗6个月以后出现局部复发、行再程放疗或放化疗的52例食管鳞癌患者的临床资料,根据其再程放疗是否联合化疗分为单纯再程放疗(re-RT)组24例和再程放疗联合化疗(RCT)组28例,观察并比较再程放疗或放化疗的近期疗效、不良反应,并且分析各临床病理因素与生存预后之间的关系,综合评价根治性放疗后复发的食管癌行再程放疗的临床价值。应用IBM SPSS Statistics 19.0统计软件进行统计处理,组间一般资料、疗效及不良反应发生率的比较采用卡方检验,采用Kaplan-Meier法制作全组及各亚组患者的生存曲线并用log-rank检验方法检验生存率差异的显著性水平,应用Cox比例风险模型进行与复发后生存期有关的单因素以及多因素分析。所有检验统计量设定为p0.05时具有统计学意义。结果全组患者再程放疗后CR者10例(19.2%),PR者26例(50.0%),SD者13例(25.0%),PD者3例(5.8%),有效(CR+PR)者36例(69.2%)。RCT组的有效率(71.4%)略高于re-RT组(58.3%),但差异无统计学意义(p=0.331)。全组发生2-3级急性放射性食管炎者21例(40.4%),re-RT组9例(37.5%),RCT组12例(42.9%)；2-3级炎急性放射性肺炎者9例(17.3%),re-RT组3例(12.5%),RCT组6例(21.4%)；2-3度骨髓抑制者21例(40.4%),re-RT组1例(4.2%),RCT组20例(71.4%)；放疗中或放疗后穿孔6例(11.5%),re-RT组2例(8.3%),RCT组4例(14.3%),放疗后狭窄4例(7.7%),re-RT组2例(8.3%),RCT组2例(7.1%),除骨髓抑制发生率RCT组显著高于re-RT组外,其余两组间不良反应发生率的差异无统计学意义。全组52例患者中位复发后生存期为11个月(95%CI 9.380-12.630),1年生存率为44.2%,2年生存率为11.5%,3年生存率为3.8%。单因素分析结果为复发间隔时间在1年以上(p=0.000)、再程放疗时PS评分0-1分(p=0.000)、再程放疗联合化疗(p=0.045)以及再程放疗的剂量"g50Gy(p=0.000)的患者的复发后生存预后相对较好,多因素分析显示再程放疗时患者的PS评分以及再程放疗是否联合化疗是影响患者预后的独立因素。再程放疗时的PS评分为0-1分者43例,中位生存期是13个月,1年生存率为53.5%；PS评分为2-3分者9例,中位生存期是8个月,1年生存率为11.1%。再程治疗方案为re-RT者24例,中位生存期是9个月,1年生存率为37.5%；再程治疗为RCT者28例,中位生存期为12个月,1年生存率为50.0%。结论对于一部分根治性放疗后局部复发的食管癌患者而言,再程放疗是可行的,可以有效控制疾病进展并改善生存预后。患者的预后与复发间隔时间、再程放疗时的PS评分、再程放疗的剂量以及再程放疗是否联合化疗有关,对于复发时PS评分0-1分、复发间隔时间为1年以上的患者,再程放疗剂量"g50Gy并联合化疗可以改善生存预后。但再程放时不良反应的发生率较首程放疗高且穿孔等严重并发症的风险明显增加,应当严格筛选病例、谨慎进行再程放疗前的评估。
[Abstract]:Background radical radiotherapy or chemoradiotherapy is now a major treatment for widely recognized unoperated esophageal cancer. However, most patients after radical radiotherapy have relapsed or metastases within 1-2 years. Local recurrence is still the main type of radical radiotherapy failure. Patients with locally recurrent esophageal cancer after radical radiotherapy are the treatment regimens. The selection is limited, mainly for surgical treatment or palliative chemotherapy, and recourse radiotherapy in some head and neck malignant tumors is proved to be effective, while the literature on recourse radiotherapy for esophageal cancer is less, and the feasibility and effectiveness of radiotherapy for recurrent patients after radical radiotherapy are still in dispute. The short term effect, adverse reaction and the survival period after recurrent radiotherapy after radical radiotherapy for patients with carcinoma of tube, the factors affecting the survival prognosis of the patients and the feasibility and clinical value of re radiotherapy for esophageal cancer were evaluated comprehensively. Methods CR or PR after radical radiotherapy or radiotherapy were reviewed. 6 months after the treatment, the clinical data of 52 cases of esophageal squamous cell carcinoma with recurrent radiotherapy or radiotherapy and radiotherapy were divided into 24 cases of re-RT group and 28 cases of radiotherapy combined with chemotherapy (RCT). And the relationship between the clinicopathological factors and the survival prognosis was analyzed. The clinical value of recourse radiotherapy for recurrent esophageal cancer after radical radiotherapy was evaluated. IBM SPSS Statistics 19 statistical software was used for statistical processing. The general data, the comparison of the curative effect and the incidence of adverse reaction were compared with the chi square test and the use of Kaplan-Meier The survival curves of the patients in the whole group and the subgroups were made and the significant level of the survival rate difference was tested by log-rank test. The Cox proportional risk model was used to carry out the single factor and multifactor analysis related to the recurrence of the survival period. All the test statistics were set as P0.05. 10 cases (19.2%), 26 cases (50%), 13 cases (25%) of SD, 3 cases (5.8%) of PD, 36 (69.2%).RCT group in CR+PR (69.2%).RCT group (71.4%) was slightly higher than that of re-RT group (58.3%), but the difference was not statistically significant (p=0.331). There were 9 cases (17.3%) with acute radiation pneumonitis, 3 cases in group re-RT (12.5%), 6 cases in group RCT (21.4%), 21 (40.4%) in 2-3 degree myelosuppressor, 1 in group re-RT (4.2%), 3 in group RCT, 3 in radiotherapy or after radiotherapy, in group RCT, re-RT group, RCT group, except bone marrow The incidence of inhibition in the RCT group was significantly higher than that in the re-RT group. There was no significant difference in the incidence of adverse reactions among the other two groups. The 52 patients in the whole group had a 11 month survival period (95%CI 9.380-12.630), the 1 year survival rate was 44.2%, the 2 year survival rate was 11.5%, and the 3 year survival rate was 3.8%. single factor analysis for 1 years for the recurrence interval of 1 years. P=0.000, PS score 0-1 (p=0.000), RRT combined with chemotherapy (p=0.045) and the recurrence of g50Gy (p=0.000) in re radiotherapy were relatively good for the survival prognosis. Multivariate analysis showed that the PS score of the patients and the combined chemotherapy of re radiotherapy were independent factors affecting the prognosis of the patients. The PS score was 0-1 in 43, with a median survival period of 13 months and 53.5% for 1 years, 9 with a PS score of 2-3, a median survival of 8 months, and 24 for re-RT in the 1 year survival rate of 11.1%., the median survival time was 9 months, the 1 year survival rate was 37.5%; The 2 month, 1 year survival rate is 50.0%. conclusion for some patients with locally recurrent esophageal cancer after radical radiotherapy. Reprocess radiotherapy is feasible. It can effectively control the progression of the disease and improve the survival prognosis. The prognosis and interval time of the patients, the PS score in the recourse radiotherapy, the dose of the re course radiotherapy, and the combination of the re radiotherapy. Chemotherapy is associated with a recurrent PS score of 0-1 and a recurrent interval of more than 1 years. "G50Gy combined with chemotherapy can improve survival prognosis. But the incidence of adverse reactions is significantly higher than the risk of severe complications such as high first course radiotherapy and perforation. Evaluation before radiotherapy.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R735.1

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