T4期胸段食管鳞癌预后及疗效分析

摘要

目的:观察T4期胸段食管鳞癌探查术后的预后及挽救性放化疗的疗效.方法:搜集了2012年2月至2015年12月在我科治疗的31例T4期食管癌患者,12例接受了剖胸探查术(探查组),19例未行探查术(非探查组).非探查组均接受了同步放化疗或序贯放化疗,探查组有5例患者接受单纯放疗,另7例接受同步放化疗或序贯放化疗.放疗方式为调强放疗,照射剂量范围为36 ～ 64Gy,化疗方案以紫杉类联合铂类为主.结果:探查组患者客观缓解率为41.7％,中位生存期为8.0个月,1年生存率为16.7％,仅有1例患者生存时间超过2年,食管瘘发生率为66.7％.而非探查组患者客观缓解率为73.7％,中位生存期为19.0个月,1年生存率为63.2％,2年生存率为36.8％ (P =0.03).结论:胸段食管鳞癌探查术后即使接受挽救性放化疗,其预后仍较差,生存率明显低于单纯根治性放化疗,并且食管瘘发生率明显增加.%Objective:To observe the prognosis and efficacy of salvage chemoradiotherapy in stage T4 thoracic esophageal squamous cell carcinoma after exploratory thoracotomy.Methods:Between February 2012 and December 2015,twelve stage T4 patients with thoracic esophageal squamous cell carcinoma accepted the exploratory thoracotomy before chemoradiotherapy (exploratory group).Nineteen patients simply accepted chemoradiotherapy (non-exploratory group).All the patients of the non-exploratory group accepted concurrent chemoradiotherapy or sequential chemoradiotherapy.Five patients of the exploratory group accepted radiotherapy alone,and the others accepted concurrent chemoradiotherapy or sequential chemoradiotherapy.Radiotherapy method was intensity modulated radiation therapy (IMRT) with the dose of 36 ～64Gy.Chemotherapy regimens consisted of taxanes and platinum.Results:Objective response rate of exploratory group was 41.7％,median survival time 8.0 months,1-year survival rate 16.7％.Only one patient survived more than 2 years.The incidence of esophageal fistula in exploratory group was 66.7％.Objective response rate of non-exploratory group was 73.7％,median survival time 19.0 months,1-year survival rate 63.2％,2-year survival rate 36.8％ (P =0.03).Conclusion:Prognosis of patients with thoracic esophageal squamous cell carcinoma accepted the exploratory thoracotomy was highly poor although accepting chemoradiotherapy.The survival rate was lower,and incidence of esophageal fistula was higher compared to definitive chemoradiotherapy.