老年食管鳞癌淋巴结累及野放疗的多中心回顾性分析

发布时间：2018-06-09 04:36

本文选题：食管癌 + 累及野照射　；参考：《浙江大学》2015年硕士论文

【摘要】：目的：比较根治性单纯放疗的老年食管鳞癌患者行淋巴结累及野照射(IFI)和预防性照射(ENI)的治疗效果和不良反应,从而探讨老年患者单纯放疗行淋巴结累及野照射的可行性。材料和方法：收集2007-2010年期间两中心经病理证实的大于70岁的老年食管鳞癌患者共79例,均行单纯根治性调强放射治疗。其中48例进行IFI放疗,31例进行ENI放疗。IFI组大体肿瘤靶体积(GTV)包括转移淋巴结及食管原发灶,临床靶体积(CTV)为阳性淋巴结外扩0.5-0.8cm,食管病灶前后左右外扩0.5-0.8cm,上、下扩3cm；ENI组GTV同IFI组,CTV1同IFI组CTV, CTV2包括预防照射的淋巴引流区,PTV为CTV外放0.5cm,处方剂量两组均为54-71Gy。中位随访时间为24个月,比较两组的疾病无进展生存率,总生存率,治疗失败模式及肺照射剂量及放射性肺炎发生率。结果：1,2,3年疾病无进展生存率,IFI组为60.4%,34.9%,29.7%,ENI组为64.5%,54.0%,35.0%,两者无进展生存率比较差异无统计学意义(P0.05)；1,2,3年总生存率IFI组为72.9%,43.4%,31.5%,ENI组为73.0%,53.0%,38.3%,中位生存期两组分别为25和28个月,ENI组有生存提高趋势,但两者差异无统计学意义(P0.05)。两组的失败模式类似,远处转移、局部复发、非受累野淋巴结复发率IFI组及ENI组分别为22.9%,27.0%,4.2%和25.8%,19.4%,0%,两组比较差异均无统计学意义(P0.05)。在治疗相关不良反应方面,ENI组中肺V5、V20、肺平均剂量等指标均大于IFI组,比较差异均有统计学意义(t=4.66、29.90、15.63,P0.05)；放射性肺炎的发生率ENI组明显高于IFI组,1-2级分别为22%和13%,3级分别为19%和4%,两组比较差异有统计学意义(χ2=4.55、4.77,P0.05)。结论：在老年食管鳞癌单纯放疗患者中,IFI与ENI的无进展生存率和生存率类似,但前者的肺受照射剂量明显减少,减少了老年人的肺损伤,是较为合适的治疗方法。
[Abstract]:Objective: to compare the therapeutic effects and side effects of lymph node involvement (IFI) and prophylactic irradiation (ENI) in elderly patients with esophageal squamous cell carcinoma treated by radical radiotherapy alone, and to explore the feasibility of radiotherapy alone in elderly patients with lymph node involvement. Materials and methods: 79 patients with esophageal squamous cell carcinoma over 70 years old confirmed by pathology from 2007 to 2010 were treated with simple radical intensity modulated radiation therapy. Among them, 48 cases were treated with IFI radiotherapy and 31 cases were treated with ENI radiotherapy. The gross tumor target volume (GTV) including metastatic lymph nodes and primary esophageal lesions was found in ENI radiotherapy. CTV (clinical target volume) was 0.5-0.8 cm in positive lymph nodes and 0.5-0.8 cm in anterior and posterior esophageal lesions. The CTV of CTV2 including the lymphoid drainage area of prevention irradiation was 0.5 cm in GTV group and CTV 1 group in IFI group, and the prescription dose was 54-71 GY in both groups. The median follow-up time was 24 months. The disease progression free survival rate, overall survival rate, failure mode of treatment, lung irradiation dose and incidence of radiation pneumonia were compared between the two groups. Results the 3 year progression free survival rate was 60.4 in the IFI group and 64.54.0 in the IFI group. There was no significant difference in the progressive survival rate between the two groups. The overall 3-year survival rate in the IFI group was 72.943.41.5ENI and 73.03.038.3in the IFI group. The survival period in the middle position group was 25 months and 28 months respectively. However, there was no significant difference between the two groups (P 0.05). The failure pattern of the two groups was similar, distant metastasis, local recurrence, non-involved field lymph node recurrence rate in IFI group and ENI group were 22.90.0.02% and 25.8%, respectively. There was no significant difference between the two groups (P 0.05). In the treatment of related adverse reactions, the lung V5V 20 and the average lung dose in the ENI group were higher than those in the IFI group. The incidence of radiation pneumonia in ENI group was significantly higher than that in IFI group (22% and 13%, 19% and 4%, respectively). The difference between the two groups was statistically significant (蠂 24.54.77 P 0.05). Conclusion: the progression-free survival rate and survival rate of IFI and ENI in elderly patients with esophageal squamous cell carcinoma treated by radiotherapy alone are similar, but the dose of lung irradiation in the former is significantly reduced and the lung injury in the elderly is reduced.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R735.1

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