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目的 为进一步估价术前放射治疗和外科手术综合治疗食管癌的近远期疗效 ,再次分析随诊满 5年以上的 418例食管癌随机分组临床研究结果。方法 1977年 6月至 1989年 4月 ,对胸中段食管癌 (按 1978年UICC分段标准 )、长度 8cm以下 (1984年起为 5～ 8cm)、年龄 <6 5岁 ,能进半流、无外科手术禁忌证的病例进行信封法随机分组 :术前放射治疗组 [(R +S) 195例 ],和单纯手术组 [(S) 2 2 3例 ]。放射治疗使用 8MVX射线 ,前后 2个野包括全纵隔及胃左动脉旁淋巴结引流区 ,剂量DT40Gy 2 0次 4周。双锁骨上区未做预防照射 ,间隔 2～ 4周后进行手术。用Kaplan Meier法计算生存率 ,Logrank检验两组的差异性。结果 R +S组和S组手术切除率分别为 90 .3%和 85 .7% (P =0 .0 8) ,术后病理淋巴结转移率分别为 2 2 .2 %和 40 .8% (P <0 .0 1) ,T4 N0 M0 +T4 N1M0 期分别占 2 9.2 %和 5 7.4% (P <0 .0 0 5 ) ;手术死亡率分别为 2 .2 %和 4.2 % ;胸内吻合口瘘发生率分别为 2 .2 %和3 .7% ,食管残端残存癌发生率分别为 0 %和 2 .1% ,局部和区域复发率分别为 2 2 .7%和 41.4% (P <0 .0 1)。R +S组生存率优于S组 (P =0 .0 2 4)。结论 术前放射治疗能降低术后病理淋巴结转移率和缩小肿瘤及明显降期作用 ;能降低局部和区域复发?
Objective To further evaluate the short- and long-term efficacy of preoperative radiotherapy and surgery for comprehensive treatment of esophageal cancer, and to reanalyze the results of randomized clinical trials of 418 patients with esophageal cancer who have been diagnosed for more than 5 years. Methods From June 1977 to April 1989, thoracic mid-segment esophageal cancer (according to UICC sub-criterion in 1978), length less than 8 cm (from 5 to 8 cm from 1984), and age < 6 5 years, was able to enter semi-flow, Cases without surgical contraindications were randomly assigned to the envelope method: preoperative radiotherapy group [(R + S) 195 cases], and surgery alone group [(S) 223 cases]. Radiation therapy used 8MV X-rays. Before and after the two fields including the mediastinal and para-aortic lymph node drainage area, the dose DT40Gy 2 0 4 weeks. The supraclavicular region was not exposed to radiation and surgery was performed 2 to 4 weeks apart. The Kaplan Meier method was used to calculate the survival rate. Logrank was used to test the differences between the two groups. Results The resection rates of R + S and S groups were 90.3% and 85.7%, respectively (P =0.08). The postoperative pathological lymph node metastases were 22. 2% and 40.8% ( P <0.01), T2N0 M0 + T4 N1M0 period accounted for 29.2% and 5 7.4% (P <0.05); Surgical mortality was 2.4% and 4.2% respectively; intrathoracic anastomosis The incidence of oral sputum was 2.2% and 3.7% respectively. The incidence of residual cancer in the esophageal stump was 0% and 2.1% respectively. The local and regional recurrence rates were 22.7% and 41.4%, respectively (P <0. 0 1). The survival rate of the R +S group was better than that of the S group (P = 0.024). Conclusion Preoperative radiotherapy can reduce postoperative pathological lymph node metastasis, reduce tumor size, and significantly reduce the effect of time. It can reduce local and regional recurrence.