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目的探讨食管癌三维适形放疗的疗效及其影响因素。方法以本院2011年1月-2013年12月收治的55例食管癌患者为研究对象,行三维适形放疗法。放疗前后采用磁共振成像(MRI)和弥散加权成像(DWI)扫描,比较放疗前后病变长度、表面弥散系数(ADC)值变化,统计放疗近期疗效及随访3年生存情况(预后),并经Cox回归模型分析影响预后的相关因素。结果食管造影显示CR 19例,PR 32例;MRI DWI显示CR 22例(食管造影PR中10例转入),PR 26例(食管造影CR中7例转入);与放疗前,放疗结束时病变长度显著缩小,差异有统计学意义(P<0.05);不同弥散敏感系数(b值)对应ADC值均显著上升,差异有统计学意义(P<0.05);随访3年共失访7例,3年无病生存率、总生存率分别为27.08%、33.33%;Cox回归模型分析食管癌患者预后独立危险因素为病变部位、肿瘤分期系统(TNM)分期。结论三维适形放疗治疗食管癌疗效较好,其预后与病变部位、TNM分期有关;MRI DWI对食管癌三维适形放疗疗效评估有重要价值。
Objective To investigate the efficacy and influential factors of three-dimensional conformal radiotherapy for esophageal cancer. Methods A total of 55 patients with esophageal cancer treated in our hospital from January 2011 to December 2013 were enrolled in this study. Three-dimensional conformal radiotherapy was used. Before and after radiotherapy, MRI and DWI were used to compare the changes of lesion length, surface diffusion coefficient (ADC) before and after radiotherapy, the recent curative effect of radiotherapy and the 3-year follow-up of survival (prognosis) Regression model analysis of prognostic factors. Results The results of esophageal angiography showed that 19 cases were CR and 32 cases were PR. MRI DWI showed CR in 22 cases (PR in esophageal angiography was transferred in 10 cases) and PR in 26 cases (esophageal CR was transferred in 7 cases). Before radiotherapy, (P <0.05); ADC value of different diffusion coefficient (b value) significantly increased, the difference was statistically significant (P <0.05); a total of 7 cases were followed up for 3 years , The 3-year disease-free survival rate and the overall survival rate were 27.08% and 33.33% respectively. Cox regression analysis showed that the independent prognostic risk factors for esophageal cancer were pathological site and TNM staging. Conclusions Three-dimensional conformal radiotherapy for esophageal cancer has good curative effect, and its prognosis is related to the location of the lesion and TNM staging. MRI DWI is of great value in assessing the efficacy of three-dimensional conformal radiotherapy for esophageal cancer.