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[1]周彬,李益坤,许清,等.螺旋断层放射治疗老年食管癌预后分析[J].医学研究与战创伤救治(原医学研究生学报),2019,21(6):603-607.[doi:10.3969/j.issn.1672-271X.2019.06.011]
　ZHOU Bin,LI Yi-kun,XU Qing,et al.Safety and efficacy of Helical tomotherapy for elderly patients with esophageal squamous cell cancer[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2019,21(6):603-607.[doi:10.3969/j.issn.1672-271X.2019.06.011]
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螺旋断层放射治疗老年食管癌预后分析()
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《医学研究与战创伤救治》（原医学研究生学报）[ISSN:1672-271X/CN:32-1713/R]

卷:
第21卷
期数:
2019年6期
页码:
603-607
栏目:
临床研究
出版日期:
2019-11-14

文章信息/Info

Title:
Safety and efficacy of Helical tomotherapy for elderly patients with esophageal squamous cell cancer
文章编号:
1672-271X（2019）06-0603-05
作者:
周彬;  李益坤;  许清;  蒋凯;  孙荣;  孙向东
210002 南京，东部战区总医院（原八一医院）全军肿瘤中心放疗科
Author(s):
ZHOU Bin;  LI Yi-kun;  XU Qing;  JIANG Kai;  SUN Rong;  SUN Xiang-dong
(Department of Radiotherapy, Cancer Center of General Hospital of Eastern Theater Command, PLA/Former PLA 81 Hospital, Nanjing 210002, Jiangsu, China)
关键词:
食管癌;  放射治疗;  螺旋断层;  老年
Keywords:
esophageal neoplasms;  radiotherapy;  Helical tomotherapy;  aged
分类号:
R735.1
DOI:
10.3969/j.issn.1672-271X.2019.06.011
文献标志码:
A
摘要:
目的 探讨螺旋断层根治性放射治疗在≥65岁食管癌患者中的疗效和安全性。 方法 回顾性分析2011年3月至2016年12月东部战区总医院（原八一医院）放疗科收治的年龄≥65岁食管癌患者40例的临床资料，其中男29例，女11例，均经病理学证实为食管鳞癌，采用螺旋断层放射治疗,处方剂量为50～70 Gy，1.8～2.0 Gy/次。其中病灶照射剂量≥60 Gy的34例，<60 Gy的6例。同步放化疗15例，单纯放疗25例。计算评估患者治疗结束1个月时总有效率、稳定率,Kaplan-Meiter法计算中位总生存期（OS）,1、2、3年生存率、局部控制率、无进展生存率(PFS)，Logrank法检验和单因素预后分析，Cox模型多因素预后分析，观察不良反应发生情况。 结果 随访率100％。近期疗效：食管癌病灶近期总有效率为89.1%，其中同步放化疗者为93.1%，单纯放疗者为83.2%（P=0.027）。病灶照射剂量≥60 Gy者总有效率90.5%，<60 Gy者总有效率85.9%（P=0.031）。远期疗效：所有患者中位OS为34.5个月，1、2、3年OS率分别为67.4％、52.9％、44.1％，１、２、３年局部控制率分别为81.2％、73.2%、60.4％。1、2、3年PFS分别为58.3%、39.8%、30.1%。单因素分析显示影响OS的因素有全身状况 ECOG评分、T分期、N分期、同步化疗、放疗剂量，多因素分析显示ECOG评分、T分期、放疗剂量是影响OS的预后因素。不良反应主要为Ⅰ～Ⅱ级放射性食管炎、放射性肺炎，患者均能耐受, 经对症处理均好转顺利完成治疗。 结论 采用螺旋断层放疗治疗老年性食管癌，将放疗剂量提高到60 Gy,患者耐受性亦良好，可延长生存、提高生活质量。
Abstract:
Objective Helical tomotherapy, an advanced intensity-modulated radiation therapy with integrated CT imaging, permits highly conformal irradiation with sparing of normal tissue. We compared the outcomes and prognostic factor in elderly patients with esophageal cancer after radiotherapy with TOMO . Methods A total of 40 patients with esophageal squamous cell cancer (age≥65) were enrolled in the clinical study. The patients were treated with Helical tomotherapy. The radiotherapy was delivered at a total dose of 50-70 Gy (1.8-2.0 Gy per fraction ). 34 patients had irradiation dose ≥60 Gy, and 6 cases had irradiation dose <60 Gy. 15 patients received concurrent chemotherapy. 25 patients received radiotherapy alone. The Kaplain- Meiter method was used to calculate overall survival (OS)，Local control rates (LC) and progression-free survival (PFS) rates. The log-rank test was used for survival difference analysis and univariate prognositic analysis. And the Cox model was used for multivariate prognostic analysis. Results Median overall survival of all patients were 34.5m. The 1-, 2- and 3-year overall survival rates of all patients were 67.4％，52.9％，44.1％, respectively. Univariate analysis indicated that ECOG， T stage，N stage，concurrent chemotherapy，radiotherapy dose were prognostic factor for OS. Multivariate analyses showed that ECOG， T stage，radiotherapy dose were independent predictors for OS. Acute late toxicities were mild or moderate. No grade IV toxicities were observed. Conclusion For non-surgical treatment of elderly patients with esophageal squamous cell cancer, radiotherapy with delivered at a total dose of ≥60 Gy is a preferred strategy and has proven to be effective and tolerable.

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备注/Memo

备注/Memo:
收稿日期：2019-02-25
更新日期/Last Update: 2019-11-15