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食管鳞癌术后局部区域复发患者接受不同照射方式获益人群的初步分析
沈文斌1, 高红梅2, 许金蕊1, 李曙光1, 李幼梅1, 祝淑钗1
1河北医科大学第四医院放疗科,石家庄 050011; 2石家庄市第一医院影像中心 050011
Preliminary analysis of the benefit groups of patients with locoregional recurrence of esophageal squamous cell carcinoma who received different patterns of irradiation
Shen Wenbin1, Gao Hongmei2, Xu Jinrui1, Li Shuguang1, Li Youmei1, Zhu Shuchai1
1Department of Radiotherapy, the Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China; 2Center of Imaging, Shijiazhuang First Hospital, Shijiazhuang 050011, China
Abstract：Objective To explore the benefit groups of patients with locoregional recurrence of esophageal thoracic squamous cell carcinoma who received radiotherapy or chemoradiotherapy with different patterns of irradiation. Methods Clinical data of 344 esophageal thoracic squamous cell carcinoma patients with postoperative recurrence who received intensity conformal radiotherapy or concurrent chemoradiotherapy in the Fourth Hospital of Hebei Medical University from 2009 to 2014 were retrospectively analyzed. The distribution of recurrence sites and prognostic factors were analyzed. A stratified analysis was carried out on the benefit groups of patients receiving the elective nodal irradiation (ENI) and involved field irradiation (IFI). Results 276 cases (80.2%) recurred at a single site and 68 cases (19.8%) recurred at more than two sites. The follow-up rate was 96.2%. The 1-, 3-and 5-year overall survival rates were 53.6%, 22.6% and 16.4%, respectively, with a median of 12.8 months (95%CI:11.3-14.3 months). The 1-, 3-and 5-year local recurrence-free survival rates were 46.5%, 16.9% and 12.0%, respectively, with a median of 11.0 months (95%CI:9.6-12.4 months). The 1-, 3-and 5-year progression-free survival rates were 39.8%, 11.3% and 6.7%, respectively, with a median of 7.9 months (95%CI:5.8-10.0 months). Multivariate analysis showed that gender, the log odds of metastatic lymph nodes (LODDS) and the number of chemotherapy cycles were the independent prognostic factors (P=0.003,<0.001,<0.001). Subgroup univariate analysis demonstrated that patients with an esophageal lesion length<5.0cm,N0stage, the number of surgically-dissected lymph nodes of ≤9,the number of postoperative positive lymph node metastasis site of 0, and LODDS≤0.030 obtained benefits from ENI (P=0.032,0.012,0.001,0.012 and 0.014). Patients with the number of surgically-dissected lymph nodes of ≥16 achieved benefits from IFI (P=0.035). Conclusions Radiotherapy is an effective treatment mode for patients with local recurrence after esophageal cancer surgery. For patients with preoperative esophagography showing shorter esophageal lesions, earlier postoperative pathological N stage, lower LODDS score, and fewer surgically-dissected lymph nodes probably obtain more benefits from ENI than IFI. However, patients with more surgically-dissected lymph nodes may obtain more benefit from IFI compared with ENI.
Shen Wenbin,Gao Hongmei,Xu Jinrui et al. Preliminary analysis of the benefit groups of patients with locoregional recurrence of esophageal squamous cell carcinoma who received different patterns of irradiation[J]. Chinese Journal of Radiation Oncology, 2021, 30(10): 1013-1018.
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2021, Vol. 30 
