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目的探讨食管癌三维适形放疗(Three-dimensional conformal radiotherapy,3DCRT)的疗效及预后影响因素。方法对新疆医科大学附属肿瘤医院放疗二科2007年1月-2009年12月收治的174例食管癌患者行3DCRT放疗(3DCRT组),并与同期行常规放疗(conventional radiotherapy,CF)(CF组)放疗的75例患者进行比较,分析近期疗效、毒副反应以及预后影响因素。结果所有患者放疗近期有效率为82.7%,其中3DCRT组放疗近期有效率为86.2%,CF组放疗近期有效率为74.7%,两组差异有统计学意义(χ2=4.88,P=0.027)。两组患者放射性食管损伤发生差异有统计学意义(χ2=8.03,P=0.045),两组患者血液毒性反应发生差异有统计学意义(χ2=9.5,P=0.023)。3DCRT组和CF组患者1、2、3年生存率分别为78.7%、43.2%、23.9%和61.4%、33.5%、17.4%,3DCRT组1、2、3年生存率高于CF组(χ2=3.89,P=0.048)。多因素分析显示临床分期、不同放疗方式是影响食管癌患者的独立预后因素(P分别为0.038、0.026)。结论 3DCRT的应用能最大限度地减少肿瘤靶区周围组织的照射剂量,降低患者血液学毒性反应,明显提高食管癌的局控率及生存率,临床分期、不同放疗方式与食管癌患者的预后相关。
Objective To investigate the efficacy and prognostic factors of three-dimensional conformal radiotherapy (3DCRT) for esophageal cancer. Methods A total of 174 patients with esophageal cancer treated with 3DCRT radiotherapy (3DCRT) were enrolled in the Department of Radiation Oncology, Affiliated Tumor Hospital, Xinjiang Medical University from January 2007 to December 2009. The patients were treated with conventional radiotherapy (CF) ) Radiotherapy 75 patients were compared to analyze the short-term efficacy, side effects and prognostic factors. Results The effective rate of radiotherapy in all patients was 82.7%. The effective rate of radiotherapy in 3DCRT group was 86.2%. The effective rate of radiotherapy in CF group was 74.7%. The difference was statistically significant (χ2 = 4.88, P = 0.027). There was significant difference in radioactive esophageal injury between the two groups (χ2 = 8.03, P = 0.045). There was significant difference in hematological toxicity between the two groups (χ2 = 9.5, P = 0.023). The 1, 2, 3-year survival rates of 3DCRT group and CF group were 78.7%, 43.2%, 23.9% and 61.4%, 33.5% and 17.4% respectively. The 1,3 and 3-year survival rates of 3DCRT group were higher than those of CF group = 3.89, P = 0.048). Multivariate analysis showed that clinical stage and different modes of radiotherapy were independent predictors of esophageal cancer (P = 0.038 and 0.026, respectively). Conclusion The application of 3DCRT can minimize the radiation dose to the tissues around the tumor target, reduce the hematological toxicity and significantly increase the control rate and survival rate of esophageal cancer, clinical stage, different radiotherapy methods and the prognosis of patients with esophageal cancer .