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目的 :观察胸段食管癌左胸路径手术后采用小T型野辅助放疗的初步结果,以明确小T型野的治疗作用及安全性。方法 :2010年1月—2011年12月上海市胸科医院放疗科收治的食管癌左胸路径根治性R0手术后患者88例。采用小T型野辅助放疗(包括双侧锁骨上区、中上纵隔和吻合口),放疗剂量为50 Gy/25次。结果 :所有患者均按计划完成治疗。15例(15/88,17%)患者出现复发转移,其中2例患者为单纯照射野内复发,2例患者为腹腔淋巴结转移,2例患者同时出现照射野内和远处转移,9例患者出现单纯远处转移。患者1、2和3年无疾病生存率分别为93.2%、80.8%和56.0%,1、2和3年总生存率分别为98.9%、84.4%和58.8%。主要不良反应为放射性肺炎、放射性食管炎、食管纤维化和放射性皮炎,无Ⅳ度以上不良反应。结论 :胸段食管癌左胸路径根治手术后采用小T型野辅助放疗后局部复发率较低,不良反应较轻,但远处转移的比例仍较高。
Objective: To observe the preliminary results of small T-field assisted radiotherapy after thoracic esophageal left-chest path surgery to clarify the therapeutic effect and safety of small T field. Methods: From January 2010 to December 2011, 88 patients with radical R0 surgery underwent left chest radiotherapy for esophageal cancer treated with radiotherapy at Shanghai Chest Hospital. Small T-field adjuvant radiotherapy (including bilateral supraclavicular region, the mediastinum and anastomosis), radiation dose of 50 Gy / 25 times. Results: All patients completed the treatment as planned. Fifteen patients (15/88, 17%) had recurrence and metastasis. Two of them were relapsed in the field of irradiation alone. Two patients had peritoneal lymph node metastasis, two patients had both intra-and distant metastasis. Nine patients appeared simple Distant metastasis. The 1, 2 and 3 year disease-free survival rates were 93.2%, 80.8% and 56.0%, respectively, and the overall survival rates at 1, 2 and 3 years were 98.9%, 84.4% and 58.8%, respectively. The main adverse reactions were radiation pneumonitis, radiation esophagitis, esophageal fibrosis and radiation dermatitis, with no grade IV adverse reactions. Conclusions: The local recurrence rate of thoracic esophageal cancer with left chest radiotherapy after radical surgery with small T field is lower, the adverse reactions are less, but the proportion of distant metastasis is still high.