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目的:观察根治性放疗后局部复发的食管癌再程放疗的临床效果。方法:选取2012年11月至2013年11月河南大学第一附属医院接收的90例根治性放疗后复发的食管癌患者,实施再程放疗,每次1.8~2.0 Gy,每周5次。照射剂量结合患者实际情况而定。总剂量为45~60 Gy。结果:84例患者顺利完成治疗,完全缓解(CR)16例,部分缓解(PR)54例,疾病稳定(SD)14例。Ⅱ级放射性食管炎者36例,Ⅲ级放射性食管炎者4例。14例为Ⅱ级放射性肺炎,2例为Ⅲ级放射性肺炎。死亡74例,10例病患在治疗后3个月发生食管穿孔,5个月后病死。6例因全身恶化。2例在接受治疗后因肺部出血病死,病死于肺部感染者共计6例,心衰8例,呼吸衰竭10例。内科合并症为12例。恶性病变20例。患者的1年和2年生存率为40%和18%。CR者生存时间均在2年以上,1年和2年生存率比较,差异具有统计学意义(P<0.05)。结论:对于放疗后复发食管癌患者,实施再程放疗技术,可全面改善临床症状,提升患者生活品质,近期效果较好,远期治疗结果尚待进一步探析。
OBJECTIVE: To observe the clinical effect of reradiation of esophageal cancer with local recurrence after radical radiotherapy. Methods: From November 2012 to November 2013, 90 patients with esophageal cancer who relapsed after radical radiotherapy received at the First Affiliated Hospital of Henan University were enrolled in this study. The patients were treated with reradiation of 1.8-2.0 Gy every 5 times a week. Irradiation dose combined with the actual situation of patients. The total dose is 45-60 Gy. Results: Of the 84 patients, 16 were successfully treated with complete remission (CR), 54 with partial remission (PR) and 14 with stable disease (SD). Ⅱ grade esophagitis in 36 cases, Ⅲ grade esophagitis in 4 cases. 14 cases of grade Ⅱ radiation pneumonitis, 2 cases of grade Ⅲ radiation pneumonitis. 74 patients died, 10 patients had esophageal perforation 3 months after treatment and died after 5 months. 6 cases of systemic deterioration. Two patients died of pulmonary hemorrhage after treatment. Six patients died of pulmonary infection, eight were heart failure, and ten were respiratory failure. Medical complications were 12 cases. 20 cases of malignant lesions. Patients have one-year and two-year survival rates of 40% and 18%. The survival time of CR patients was more than 2 years, and the difference of 1-year and 2-year survival rates was statistically significant (P <0.05). Conclusion: Radiotherapy after esophageal cancer recurrence, the implementation of re-radiation therapy can improve clinical symptoms and improve the quality of life of patients, the recent effect is better, the results of long-term treatment remains to be further explored.