3D-CRT放疗用于高龄食管癌患者治疗的临床效果及预后分析
|
摘要
目的探讨三维适形(3DCRT)放疗用于高龄食管癌患者的短期疗效及长期预后。方法回顾性分析经胃镜病理与食管X线检测确诊的高龄(75岁以上)食管癌患者80例临床资料,所有患者均行3DCRT放疗,对可能影响其短期治疗效果的因素进行分析,同时对患者行电话随访,每3个月随访1次,分析3DCRT放疗后的近期及远期治疗效果,计算患者1年、2年与3年生存率状况,对死亡患者数量和死因详细记录,同时观察患者不良反应出现情况。结果治疗1个月后CR患者27例,PR患者45例,SD患者5例,PD患者3例,总的有效率为90%。单因素分析显示患者进食梗阻程度和病灶长度与短期疗效有关(P <0. 05);多因素分析显示,影响患者短期疗效的独立影响因素为病灶长度(OR=0. 173,95%CI=0. 782～1. 073,P <0. 05)。截止2017年10月,死亡患者64例,其中7例为肺部感染引发呼吸衰竭、31例为淋巴结及远处转移、19例为局部复发、其他因素7例。患者1年生存率66. 25%、2年生存率36. 25%、3年生存率20. 0%,平均生存时间(21. 7±5. 3)月。结论 3DCRT对高龄食管癌患者短期治疗效果理想,同时可提升患者生存率和生存质量,安全性较高。
Objective To analyze the short-term effect and long-term prognosis of elderly patients with esophageal cancer by three-dimensional conformal radiotherapy( 3 DCRT). Methods A retrospective analysis of 80 elderly patients( 75 years of age) with esophageal cancer confirmed by gastroscopic pathology and esophageal X-ray examination. All patients underwent3 DCRT radiotherapy and collected The clinical data of the patients were analyzed on the factors that may affect their short-term therapeutic effect. At the same time,the patients were followed up by phone and followed up every three months to analyze the short-term and long-term therapeutic effects after 3 DCRT radiotherapy. 3-year survival rate,detailed records of the number of deaths and causes of death,and observe the patient's adverse reaction. Results In one month,there were 27 CR patients,45 PR patients,5 SD patients and 3 PD patients. The total effective rate was 90%. Univariate analysis showed that there was a significant difference in short-term effect between obstruction and lesion length Statistical significance( P < 0. 05) Multivariate analysis showed that the independent influencing factors of short-term curative effect were length of lesion( OR = 0. 173,95% CI = 0. 782～ 1. 073,P < 0. 05); as of October 2017,64 patients died,of which 7 were lung Infection caused respiratory failure,31 cases of lymph node and distant metastasis,19 cases of local recurrence,other factors in 7 cases. The 1-year survival rate was 66. 25%,the2-year survival rate was 36. 25%,the 3-year survival rate was 20. 0% and the average survival time was 21. 7 ± 5. 3 months. Conclusion 3 DCRT is effective in short-term treatment of elderly patients with esophageal cancer,and can improve the survival rate and quality of life of patients with high safety.
Objective To analyze the short-term effect and long-term prognosis of elderly patients with esophageal cancer by three-dimensional conformal radiotherapy( 3 DCRT). Methods A retrospective analysis of 80 elderly patients( 75 years of age) with esophageal cancer confirmed by gastroscopic pathology and esophageal X-ray examination. All patients underwent3 DCRT radiotherapy and collected The clinical data of the patients were analyzed on the factors that may affect their short-term therapeutic effect. At the same time,the patients were followed up by phone and followed up every three months to analyze the short-term and long-term therapeutic effects after 3 DCRT radiotherapy. 3-year survival rate,detailed records of the number of deaths and causes of death,and observe the patient's adverse reaction. Results In one month,there were 27 CR patients,45 PR patients,5 SD patients and 3 PD patients. The total effective rate was 90%. Univariate analysis showed that there was a significant difference in short-term effect between obstruction and lesion length Statistical significance( P < 0. 05) Multivariate analysis showed that the independent influencing factors of short-term curative effect were length of lesion( OR = 0. 173,95% CI = 0. 782～ 1. 073,P < 0. 05); as of October 2017,64 patients died,of which 7 were lung Infection caused respiratory failure,31 cases of lymph node and distant metastasis,19 cases of local recurrence,other factors in 7 cases. The 1-year survival rate was 66. 25%,the2-year survival rate was 36. 25%,the 3-year survival rate was 20. 0% and the average survival time was 21. 7 ± 5. 3 months. Conclusion 3 DCRT is effective in short-term treatment of elderly patients with esophageal cancer,and can improve the survival rate and quality of life of patients with high safety.
引文
[1]王盛超,刘书文,贾明选,等.图像引导下三维适形放疗及序贯化疗治疗老年非小细胞肺癌患者的中短期疗效〔J〕.检验医学与临床,2016,13(19):2814-2816.
[2]李德凡,杨帆,蒋淑年,等.三维适形放疗对80岁以上老年食管癌患者的疗效与安全性评价〔J〕.癌症进展,2015,3(4):425-428.
[3]刘俊才,吴大鹏,张洪志,等.三维适形放疗联合替吉奥同步化疗治疗老年食管癌疗效观察〔J〕.山东医药,2016,56(3):70-71.
[4] Zelefsky MJ,Cowen D,Fuks Z,et al. Long term tolerance of high dose three-dimensional conformal radiotherapy in patients with localized prostate carcinoma〔J〕. Cancer,2015,85(11):2460-2468.
[5]万钧,肖爱勤,高淑珍,等.食管癌放疗后近期疗效评价标准--附1000例分析〔J〕.中华放射肿瘤学杂志,1989,2(4):3-5.
[6] Freilich J,Hoffe SE,Almhanna K,et al. Comparative outcomes for three-dimensional conformal versus intensitymodulated radiation therapy for esophageal cancer〔J〕. Diseases of the Esophagus Official Journal of the International Society for Diseases of the Esophagus,2015,28(4):352-355.
[7]段伟,刘宁宁,高娜,等.老年食管癌三维适形放疗与调强放疗同步奈达铂化疗疗效观察〔J〕.现代医学,2015,1(2):187-190.
[8]汪超,彭万仁,汤晓伟,等. 75岁以上老年食管癌适形放疗疗效分析〔J〕.现代肿瘤医学,2016,24(14):2240-2243.
[9] Lin SH,Zhang N,Godby J,et al. Radiation modality use and cardiopulmonary mortality risk in elderly patients with esophageal cancer〔J〕. Cancer,2015,122(6):917-928.
[10]黄璜,桂伟伟,赵怡.榄香烯口服乳联合三维适形放疗治疗老年食管癌患者疗效观察〔J〕.实用临床医药杂志,2015,19(1):80-81.
[11] Haefner MF,Lang K,Verma V,et al. Intensity-modulated versus 3-dimensional conformal radiotherapy in the definitive treatment of esophageal cancer:comparison of outcomes and acute toxicity〔J〕. Radiation Oncology,2017,12(1):131-134.
[12]廖晓宁,罗彪,张倬彬,等.早期生长转录因子-1表达水平对食管癌三维适形放疗临床疗效及预后的影响〔J〕.广西医学,2017,39(2):147-149.
[13]洪英财,陈怀生,林少霖,等.三维适形放疗联合同步化疗治疗食管癌的临床疗效分析〔J〕.实用癌症杂志,2015,9(12):1927-1930.
[14]邱恩毅,赵喜越,金璋,等.三维适形放疗同步替吉奥治疗中国老年食管癌的荟萃分析〔J〕.肿瘤学杂志,2015,21(10):819-827.
[15] Ono T,Nakamura T,Azami Y,et al. Clinical results of proton beam therapy for twenty older patients with esophageal cancer.〔J〕. Radiology Oncology,2015,49(4):371-376.
[16]赵一虹,许卫东,张富利. TOMOX方案联合三维适形放射治疗中晚期食管癌的近期疗效及不良反应观察〔J〕.中国医学装备,2016,13(10):61-64.
[17]邵海君,洪伟丰,应军盛,等.后程加速超分割三维适形放疗同步化疗治疗食管癌的疗效分析〔J〕.中国中西医结合消化杂志,2016,4(2):104-107.
[18]梁英魁,康静波,郭烽,等. 18F-FDG PET/CT在晚期肺癌三维适形放疗的靶区勾画中的价值及对短期疗效和预后的影响〔J〕.临床和实验医学杂志,2017,16(13):1337-1341.
[2]李德凡,杨帆,蒋淑年,等.三维适形放疗对80岁以上老年食管癌患者的疗效与安全性评价〔J〕.癌症进展,2015,3(4):425-428.
[3]刘俊才,吴大鹏,张洪志,等.三维适形放疗联合替吉奥同步化疗治疗老年食管癌疗效观察〔J〕.山东医药,2016,56(3):70-71.
[4] Zelefsky MJ,Cowen D,Fuks Z,et al. Long term tolerance of high dose three-dimensional conformal radiotherapy in patients with localized prostate carcinoma〔J〕. Cancer,2015,85(11):2460-2468.
[5]万钧,肖爱勤,高淑珍,等.食管癌放疗后近期疗效评价标准--附1000例分析〔J〕.中华放射肿瘤学杂志,1989,2(4):3-5.
[6] Freilich J,Hoffe SE,Almhanna K,et al. Comparative outcomes for three-dimensional conformal versus intensitymodulated radiation therapy for esophageal cancer〔J〕. Diseases of the Esophagus Official Journal of the International Society for Diseases of the Esophagus,2015,28(4):352-355.
[7]段伟,刘宁宁,高娜,等.老年食管癌三维适形放疗与调强放疗同步奈达铂化疗疗效观察〔J〕.现代医学,2015,1(2):187-190.
[8]汪超,彭万仁,汤晓伟,等. 75岁以上老年食管癌适形放疗疗效分析〔J〕.现代肿瘤医学,2016,24(14):2240-2243.
[9] Lin SH,Zhang N,Godby J,et al. Radiation modality use and cardiopulmonary mortality risk in elderly patients with esophageal cancer〔J〕. Cancer,2015,122(6):917-928.
[10]黄璜,桂伟伟,赵怡.榄香烯口服乳联合三维适形放疗治疗老年食管癌患者疗效观察〔J〕.实用临床医药杂志,2015,19(1):80-81.
[11] Haefner MF,Lang K,Verma V,et al. Intensity-modulated versus 3-dimensional conformal radiotherapy in the definitive treatment of esophageal cancer:comparison of outcomes and acute toxicity〔J〕. Radiation Oncology,2017,12(1):131-134.
[12]廖晓宁,罗彪,张倬彬,等.早期生长转录因子-1表达水平对食管癌三维适形放疗临床疗效及预后的影响〔J〕.广西医学,2017,39(2):147-149.
[13]洪英财,陈怀生,林少霖,等.三维适形放疗联合同步化疗治疗食管癌的临床疗效分析〔J〕.实用癌症杂志,2015,9(12):1927-1930.
[14]邱恩毅,赵喜越,金璋,等.三维适形放疗同步替吉奥治疗中国老年食管癌的荟萃分析〔J〕.肿瘤学杂志,2015,21(10):819-827.
[15] Ono T,Nakamura T,Azami Y,et al. Clinical results of proton beam therapy for twenty older patients with esophageal cancer.〔J〕. Radiology Oncology,2015,49(4):371-376.
[16]赵一虹,许卫东,张富利. TOMOX方案联合三维适形放射治疗中晚期食管癌的近期疗效及不良反应观察〔J〕.中国医学装备,2016,13(10):61-64.
[17]邵海君,洪伟丰,应军盛,等.后程加速超分割三维适形放疗同步化疗治疗食管癌的疗效分析〔J〕.中国中西医结合消化杂志,2016,4(2):104-107.
[18]梁英魁,康静波,郭烽,等. 18F-FDG PET/CT在晚期肺癌三维适形放疗的靶区勾画中的价值及对短期疗效和预后的影响〔J〕.临床和实验医学杂志,2017,16(13):1337-1341.