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目的:观察食管癌三维适形放疗疗效,对各项相关因素进行单因素、多因素预后分析,以求得到合理的预测性指标。方法:100例首程治疗的食管癌患者接受三维适形放射治疗,全组处方剂量56～70Gy,中位处方剂量64Gy,2Gy/次,1次/d,5次/周。观察其疗效,对患者的一般临床因素和肿瘤局部因素进行单因素、多因素预后分析。结果:全组患者完全缓解(CR)64例(65%),部分缓解(PR)34例(34%),无缓解(NR)2例,肿瘤总有效率(CR+PR)为98%。1、2和3年局部控制率分别为73.49%、55.21%和42.77%,1、2和3年总生存率分别为73.25%、48.09%和43.39%,中位生存期24个月。单因素分析显示,处方剂量、近期疗效、≥2级的放射性肺炎发生情况、肿瘤T和N分期、GTV长度、最大横径及GTV体积为食管癌患者放疗的预后因素;多因素分析显示,GTV体积、≥2级的放射性肺炎发生情况和近期疗效是预后的独立影响因素。对于肿瘤体积较大的患者,处方剂量≤64Gy组与>64Gy组的1、2和3年生存率分别为56.75%、56.75%、28.37%和52.94%、24.06%、24.06%,χ2=0.15,P=0.6964。结论:三维适形放疗是治疗食管癌的有效手段,肿瘤局部因素对其预后具有较好的预测性,GTV体积、≥2级的放射性肺炎发生情况和近期疗效是独立的影响因素,对肿瘤体积较大的患者不宜强行追求高剂量照射。
OBJECTIVE: To observe the curative effect of three-dimensional conformal radiotherapy of esophageal cancer, and analyze the related factors by single factor and multi-factor prognosis in order to obtain reasonable predictive index. Methods: 100 cases of esophageal cancer patients treated with first-line therapy underwent three-dimensional conformal radiotherapy. The whole prescription dose was 56-70 Gy. The median prescription dose was 64 Gy, 2Gy / time, once / d and 5 times / week. Observe its curative effect, carry on univariate and multivariate prognosis analysis to general clinical factor and local tumor factor of patient. Results: All the patients achieved complete remission (CR) in 64 cases (65%), partial remission (PR) in 34 cases (34%), no remission in 2 cases and total tumor response rate (CR + PR) The 1, 2 and 3 year local control rates were 73.49%, 55.21% and 42.77% respectively. The overall survival rates at 1, 2 and 3 years were 73.25%, 48.09% and 43.39%, respectively. The median survival time was 24 months. Univariate analysis showed that prescription dose, short-term curative effect, grade 2 pneumonitis, tumor T and N staging, GTV length, maximum transverse diameter and GTV volume were prognostic factors of radiotherapy for esophageal cancer patients. Multivariate analysis showed that GTV Volume, ≥2 levels of the occurrence of radiation pneumonitis and recent efficacy is an independent prognostic factor. For patients with larger tumor volume, the 1, 2 and 3-year survival rates were 56.75%, 56.75%, 28.37% and 52.94%, 24.06%, 24.06%, χ2 = 0.15, P = 0.6964. Conclusion: Three-dimensional conformal radiotherapy is an effective treatment for esophageal cancer. Local tumor factors have a good predictive value for prognosis. The incidence of GTV volume, grade ≥2 radiation pneumonitis and recent efficacy are independent influencing factors. The tumor volume Larger patients should not be forced to pursue high-dose irradiation.