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目的：分析食管癌术后锁骨上和(或)纵隔淋巴结转移患者放射治疗的疗效、治疗失败原因以及食管癌术后行局部小野放疗的疗效和影响局控率的预后因素。方法：患者分为两组：(1)淋巴结转移组(第1组)为69例术后锁骨上和(或)纵隔淋巴结转移的食管癌放疗病例,放疗的范围仅包括转移淋巴结区域。(2)术后局部小野放疗组(第2组)为术后放疗的食管鳞癌86例,放疗的范围仅包括肿瘤瘤床,常规分割,中位总剂量59．65 Gy,30分次,42d完成。结果：第1组1、2、3年总生存率分别为66．4%,31．1%和11．1%,死亡54例,其中远处转移38例,(70．4%)。第2组中位随访时间47．4个月,1、3、5年生存率分别为：77．4%、42．5%和30．3%。1、3、5年局控率分别为：88．8%、72．0%和57．4%,影响局控率的独立预后因素是肿瘤是否残留。放疗剂量50～60Gy的生存率最佳。结论：食管癌术后锁骨上和(或)纵隔淋巴结转移患者的主要失败原因是远处转移,规则足量化疗是必要的。食管癌术后行局部小野放疗的疗效与包括纵隔和双锁骨上大野放疗的疗效相似。
OBJECTIVE: To analyze the efficacy of radiotherapy in patients with supraclavicular and / or mediastinal lymph node metastases after esophageal cancer surgery, the causes of treatment failure and the effect of local small-field radiotherapy on postoperative esophageal cancer and prognostic factors. Methods: The patients were divided into two groups: (1) lymph node metastasis group (group 1) was treated by radiotherapy of 69 cases of esophageal cancer after supraclavicular and / or mediastinal lymph node metastasis. The scope of radiotherapy included only the metastatic lymph node area. (2) 86 cases of esophageal squamous cell carcinoma were treated with local Ono radiotherapy (group 2) after radiotherapy. The range of radiotherapy included tumor bed only. The total median dose was 59.65 Gy, 30 times, 42d completed. Results: The 1, 2 and 3 year overall survival rates in group 1 were 66.4%, 31.1% and 11.1%, respectively, 54 deaths, of which 38 were distant metastases (70.4%). The median follow-up time in group 2 was 47.4 months, and the 1, 3, 5-year survival rates were 77.4%, 42.5% and 30.3%, respectively. One, three, and five years, the local control rates were 88.8%, 72.0% and 57.4%, respectively. The independent prognostic factors affecting the rate of control were whether the tumor remained or not. Radiation dose 50 ~ 60Gy the best survival rate. CONCLUSIONS: The primary cause of failure of supraclavicular and / or mediastinal lymph node metastases following esophagectomy is distant metastasis, and regular and adequate chemotherapy is necessary. Local Otorhinolaryngotherapy after resection of esophageal cancer is similar in efficacy to radiotherapy including mediastinum and double supraclavicular surgery.