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目的 探讨手术困难的食管癌行术前剂量放疗后是否都需要手术。方法 经病理证实的 114例直接手术困难的食管癌接受术前常规分割放疗再手术 (简称术前组 ) ,选用同时期条件相近的 114例接受单纯放疗者作对照 (简称单放组 )。两组均对穿野照射肿瘤区DT40Gy/4周 ,病变在胸上段者加双锁骨区预防照射DT45～ 5 0Gy/4～ 5周。单放组加量至DT6 0～ 6 8Gy/6～ 7周 ,术前组休息 2～ 3周手术。 结果 1、3、5年生存率 ,术前组和单放组分别为 79.4%、46 .3 %、2 9.4%和 6 2 .4%、34.3 %、17.6 % ;术前放疗后X线示疗效Ⅰ、Ⅱ级者 ,两组生存相近 ;Ⅲ、Ⅳ级者 ,术前组的生存率明显优于单放组。Cox模型多因素分析影响预后因素。术前组局部复发明显减少 (P <0 .0 5 )。结论 手术困难的食管癌术前放疗后X线疗效示Ⅰ、Ⅱ级者 ,可以不手术而继续放疗至根治量 ;Ⅲ、Ⅳ级者则应尽可能争取手术。
Objective To investigate whether surgery for esophageal cancer requires preoperative radiotherapy. Methods One hundred and fourty-four patients with esophageal cancer who had direct surgical difficulties confirmed by pathology were treated with conventional radiotherapy (pre-operatively). One hundred and seventy-four patients undergoing radiotherapy were selected as the control group. Both groups were exposed to field radiation DT40Gy / 4 weeks, lesions in the thoracic segment plus double-clavicle prevention of radiation DT45 ~ 5 0Gy / 4 ~ 5 weeks. Put the amount of single group to DT6 0 ~ 6 8Gy / 6 ~ 7 weeks, preoperative group rest 2 to 3 weeks surgery. Results The 1-, 3- and 5-year survival rates were 79.4%, 46.3%, 29.4% and 62.4%, 34.3% and 17.6% in the preoperative and postoperative radiotherapy groups respectively. The efficacy of Ⅰ, Ⅱ grade, the two groups were similar survival; Ⅲ, Ⅳ grade, preoperative survival rate was significantly better than the single group. Cox model multivariate analysis of prognostic factors. Preoperative local recurrence was significantly reduced (P <0. 05). Conclusions The preoperative radiotherapy for esophageal carcinoma with esophageal cancer showed that patients with stage Ⅰ and Ⅱ radiotherapy can continue radiotherapy to radical without surgery. Patients with stage Ⅲ and Ⅳ should seek surgery as much as possible.