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中华放射肿瘤学杂志
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中华放射肿瘤学杂志  2017, Vol. 26 Issue (9): 1006-1011    DOI: 10.3760/cma.j.issn.1004-4221.2017.09.006
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食管癌同期放化疗不同放疗剂量远期疗效分析
任雪姣,王澜,韩春,丁博月,韩晶,尤杨
050011 石家庄,河北医科大学第四医院放疗科
Long-term efficacy of concurrent chemoradiotherapy at different radiotherapy doses in treatment of esophageal carcinoma
Ren Xuejiao,Wang Lan,Han Chun,Ding Boyue,Han Jing,You Yang
Department of Radiation Oncology,Fourth Hospital of Hebei Medical University,Shijiazhung 050011,China
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摘要 目的 比较食管癌同期放化疗不同放疗剂量的LC、长期OS及临床不良反应情况。方法 选取2004—2013年间本院接受同期放化疗的373例食管鳞癌患者,根据放疗剂量分为<60 Gy组99例、60 Gy组155例、>60 Gy组119例。采用Kaplan-Meier法计算LC、OS率并Logrank检验和单因素预后分析,Cox模型多因素预后分析。结果 放疗剂量<60 Gy组,60 Gy组和>60 Gy组3、5、7、10年样本量分别为97、96、56、38例,146、141、72、17例和118、115、56、20例,其LC率分别为55.3%、51.4%、48.9%、48.9%,65.1%、60.1%、55.1%、55.1%和49.4%、45.1%、37.7%、37.7%(8年)(P=0.020);OS率分别为35.4%、26.1%、22.0%、22.0%,49.0%、41.3%、32.1%、28.9%和31.1%、25.2%、14.5%、12.9%(8年)(P=0.000)。单因素分析结果显示肿瘤体积≤44 cm3、Ⅰ—Ⅱ期患者60 Gy组LC率优于<60 Gy组(P=0.040、0.035),而OS率则优于其他两组(P=0.001、0.003,P=0.045、0.006);而对于肿瘤体积>44 cm3、Ⅲ期患者60 Gy组LC率优于>60 Gy组(P=0.011、0.015),OS率优于其他两组(P=0.045、0.006,P=0.033、0.002)。>60 Gy组RE、RP发生率高于其他两组(P=0.007、0.033)。多因素分析结果显示放疗剂量及非手术T分期、N分期是预后影响因素(P=0.004、0.008、0.037)。结论 食管癌同期放化疗剂量以60 Gy为优,接受>60 Gy放疗剂量患者不良反应显著增加。
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作者相关文章
任雪姣
王澜
韩春
丁博月
韩晶
尤杨
关键词 食管肿瘤/放射疗法食管肿瘤/化学疗法预后    
AbstractObjective To compare the local control (LC), long-term overall survival (OS), and clinical adverse reactions in esophageal carcinoma patients receiving concurrent chemoradiotherapy at different radiotherapy doses. Methods A total of 373 esophageal carcinoma patients who received concurrent chemoradiotherapy in our hospital during 2004-2013 were included in this retrospective study. These patients were divided into<60 Gy group (n=99), 60 Gy group (n=155), and>60 Gy group (n=119) based on the dose of radiation. The Kaplan-Meier method was used to calculate LC and OS rates;the log-rank test was used for survival comparison and univariate prognostic analysis;the Cox model was used for multivariate prognostic analysis. Results The 3-, 5-, 7-, and 10-year sample sizes were 97,96,56, and 38 in the<60 Gy group, 146,141,72, and 17 in the 60 Gy group, and 118,115,56, and 20 in the>60 Gy group. The 3-, 5-, 7-, and 10-year LC rates were 55.3%, 51.4%, 48.9%, and 48.9% in the<60 Gy group, 65.1%, 60.1%, 55.1%, and 55.1% in the 60 Gy group, and 49.4%, 45.1%, 37.7%, and 37.7%(8-year) in the>60 Gy group (P=0.020). The 3-, 5-, 7-, and 10-year OS rates were 35.4%, 26.1%, 22.0%, and 22.0% in the<60 Gy group, 49.0%, 41.3%, 32.1%, and 28.9% in the 60 Gy group, and 31.1%, 25.2%, 14.5%, and 12.9%(8-year) in the>60 Gy group (P=0.000). The univariate analysis showed that for stage Ⅱ esophageal carcinoma patients with gross tumor volume (GTV) ≤44 cm3, the LC rate was higher in the 60 Gy group than in the<60 Gy group (P=0.040,0.035), and the OS rate was higher in the 60 Gy group than in the other two groups (P=0.001,0.003 and P=0.045,0.006). Similarly, for stage Ⅲ esophageal carcinoma patients with GTV>44 cm3, the LC rate was higher in the 60 Gy than in the>60 Gy group (P=0.011,0.015), and the OS rate was higher in the 60 Gy group than in the other two groups (P=0.045,0.006 and P=0.033,0.002). The incidence rates of acute radiation esophagitis and radiation pneumonia were significantly higher in the>60 Gy group than in the other two group (P=0.007,0.033). Furthermore, the multivariate analysis indicated that radiotherapy dose, T stage, and N stage were independent prognostic factors for esophageal carcinoma (P=0.004,0.008,0.037). Conclusions Concurrent chemoradiotherapy at 60 Gy is most efficacious for patients with esophageal carcinoma, and the radiotherapy dose of>60 Gy significantly increases the incidence of adverse reactions.
Key words Esophageal neoplasms/radiotherapy    Esophageal neoplasms/chemotherapy    Prognosis   
收稿日期: 2017-02-27     
通讯作者: 韩春,Email:hanchun2006@126.com   
引用本文:   
任雪姣,王澜,韩春等. 食管癌同期放化疗不同放疗剂量远期疗效分析[J]. 中华放射肿瘤学杂志, 2017, 26(9): 1006-1011.
Ren Xuejiao,Wang Lan,Han Chun et al. Long-term efficacy of concurrent chemoradiotherapy at different radiotherapy doses in treatment of esophageal carcinoma[J]. Chinese Journal of Radiation Oncology, 2017, 26(9): 1006-1011.
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