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食管癌治疗后区域淋巴结复发,是影响食管癌预后的重要因素。因其大多已失去再次手术或放疗的机会,只能采取化疗、中药或免疫治疗,但疗效差。我科于1993年对10例食管中段癌治疗后局部受控但有纵隔淋巴结复发的患者,采用CT定位,多野再程放疗,同时结合化疗,取得了满意的效果。现报告如下: 1 临床资料 1.1 一般资料 本组食管中段癌10例患者均男性,年龄为58～65岁,平均62.5岁。5例为术后放疗后,5例为单纯放疗后;放疗量50～70Gy。6例在治疗1年后出现主动脉旁淋巴结转移,4例在治疗2年后出现肺门淋巴结转移。 1.2 CT资料 本组患者均行CT检查,食管病变受控,未见明显外侵,但分别有肺门淋巴结及主动脉旁淋巴结转移,转移淋巴结直径为1.5～2cm,平均1.7cm。 1.3 治疗方法 对患者采用CT定位,取治疗体位,使用固定装置。肿瘤区域局部图像得到后,使CT的十字线通过肿瘤的中心,并在患者的体表上做好标记,同时在该处放一小块钡胶以便显示在CT影像上。综合这些横断体层图像,可以确定肿瘤范围及治疗区的长度。随后将这些信息传输至与CT相关的治疗计划系统。调整计划系统使CT影像上定位与建议的治疗靶区中心附合,用光笔画出体模,采用多野避开重要脏器只包住转移淋巴结外2cm行放疗,放射野约4cm×5cm大小,放疗量65Gy,同时?
Regional lymph node recurrence after esophageal cancer treatment is an important factor affecting the prognosis of esophageal cancer. Because most of them have lost the chance of reoperation or radiotherapy, they can only take chemotherapy, Chinese medicine or immunotherapy, but the curative effect is poor. Our department in 1993 on 10 cases of esophageal cancer after treatment of locally controlled but with mediastinal lymph node recurrence in patients with CT positioning, multi-field re-radiation therapy, combined with chemotherapy, and achieved satisfactory results. Now report as follows: 1 Clinical data 1.1 General information The middle of this group of 10 cases of esophageal cancer patients were male, aged 58 to 65 years, mean 62.5 years. 5 cases were postoperative radiotherapy, 5 cases after radiotherapy alone; radiotherapy 50 ~ 70Gy. Six cases showed para-aortic lymph node metastasis 1 year after treatment and four cases had hilar lymph node metastasis 2 years after treatment. 1.2 CT data in this group of patients underwent CT examination, esophageal disease control, no significant invasion, but respectively hilar lymph node and aortic lymph node metastasis, lymph node metastasis diameter of 1.5 ~ 2cm, an average of 1.7cm. 1.3 treatment of patients with CT positioning, take the treatment position, the use of fixed devices. After obtaining the local image of the tumor area, the crosshairs of the CT are passed through the center of the tumor and marked on the patient’s body surface while a small piece of barium gel is placed there for display on the CT image. Combined with these transection images, the extent of the tumor and the length of the treatment area can be determined. This information is then transmitted to the CT-related treatment planning system. Adjust the planning system so that the positioning of the CT image and the proposed target center of treatment attached to the light stroke to draw the phantom, the use of many fields to avoid important organs only metastasis lymph node 2cm radiotherapy and radiotherapy about 4cm × 5cm size, Radiation therapy 65Gy, at the same time?