本文選題：食管癌 + 根治性放療�。� 參考：《山東大學》2015年碩士論文

【摘要】：研究背景根治性放療或放化療現(xiàn)已是被廣泛認可的未手術食管癌的主要治療方案,然而根治性放療后的多數(shù)病人在1-2年內(nèi)出現(xiàn)復發(fā)或轉(zhuǎn)移,局部復發(fā)依然是根治性放療失敗的主要類型。根治性放療后局部復發(fā)的食管癌患者,治療方案的選擇較為局限,主要是手術治療或者姑息性化療,一些頭頸部惡性腫瘤的再程放療被證實是有效的,而關于食管癌再程放療的文獻資料較少,對根治性放療后復發(fā)的患者再次采用放射治療的可行性和有效性仍存爭議。目的觀察研究食管癌根治性放療后局部復發(fā)的患者行再程放療的近期療效、不良反應以及復發(fā)后生存期,分析影響患者復發(fā)后生存預后的各種因素,綜合評價食管癌再程放療的可行性和臨床價值。方法回顧性收集根治性放療或放化療后CR或PR、并在首次治療6個月以后出現(xiàn)局部復發(fā)、行再程放療或放化療的52例食管鱗癌患者的臨床資料,根據(jù)其再程放療是否聯(lián)合化療分為單純再程放療(re-RT)組24例和再程放療聯(lián)合化療(RCT)組28例,觀察并比較再程放療或放化療的近期療效、不良反應,并且分析各臨床病理因素與生存預后之間的關系,綜合評價根治性放療后復發(fā)的食管癌行再程放療的臨床價值。應用IBM SPSS Statistics 19.0統(tǒng)計軟件進行統(tǒng)計處理,組間一般資料、療效及不良反應發(fā)生率的比較采用卡方檢驗,采用Kaplan-Meier法制作全組及各亞組患者的生存曲線并用log-rank檢驗方法檢驗生存率差異的顯著性水平,應用Cox比例風險模型進行與復發(fā)后生存期有關的單因素以及多因素分析。所有檢驗統(tǒng)計量設定為p0.05時具有統(tǒng)計學意義。結(jié)果全組患者再程放療后CR者10例(19.2%),PR者26例(50.0%),SD者13例(25.0%),PD者3例(5.8%),有效(CR+PR)者36例(69.2%)。RCT組的有效率(71.4%)略高于re-RT組(58.3%),但差異無統(tǒng)計學意義(p=0.331)。全組發(fā)生2-3級急性放射性食管炎者21例(40.4%),re-RT組9例(37.5%),RCT組12例(42.9%)；2-3級炎急性放射性肺炎者9例(17.3%),re-RT組3例(12.5%),RCT組6例(21.4%)；2-3度骨髓抑制者21例(40.4%),re-RT組1例(4.2%),RCT組20例(71.4%)；放療中或放療后穿孔6例(11.5%),re-RT組2例(8.3%),RCT組4例(14.3%),放療后狹窄4例(7.7%),re-RT組2例(8.3%),RCT組2例(7.1%),除骨髓抑制發(fā)生率RCT組顯著高于re-RT組外,其余兩組間不良反應發(fā)生率的差異無統(tǒng)計學意義。全組52例患者中位復發(fā)后生存期為11個月(95%CI 9.380-12.630),1年生存率為44.2%,2年生存率為11.5%,3年生存率為3.8%。單因素分析結(jié)果為復發(fā)間隔時間在1年以上(p=0.000)、再程放療時PS評分0-1分(p=0.000)、再程放療聯(lián)合化療(p=0.045)以及再程放療的劑量"g50Gy(p=0.000)的患者的復發(fā)后生存預后相對較好,多因素分析顯示再程放療時患者的PS評分以及再程放療是否聯(lián)合化療是影響患者預后的獨立因素。再程放療時的PS評分為0-1分者43例,中位生存期是13個月,1年生存率為53.5%；PS評分為2-3分者9例,中位生存期是8個月,1年生存率為11.1%。再程治療方案為re-RT者24例,中位生存期是9個月,1年生存率為37.5%；再程治療為RCT者28例,中位生存期為12個月,1年生存率為50.0%。結(jié)論對于一部分根治性放療后局部復發(fā)的食管癌患者而言,再程放療是可行的,可以有效控制疾病進展并改善生存預后�；颊叩念A后與復發(fā)間隔時間、再程放療時的PS評分、再程放療的劑量以及再程放療是否聯(lián)合化療有關,對于復發(fā)時PS評分0-1分、復發(fā)間隔時間為1年以上的患者,再程放療劑量"g50Gy并聯(lián)合化療可以改善生存預后。但再程放時不良反應的發(fā)生率較首程放療高且穿孔等嚴重并發(fā)癥的風險明顯增加,應當嚴格篩選病例、謹慎進行再程放療前的評估。
[Abstract]:Background radical radiotherapy or chemoradiotherapy is now a major treatment for widely recognized unoperated esophageal cancer. However, most patients after radical radiotherapy have relapsed or metastases within 1-2 years. Local recurrence is still the main type of radical radiotherapy failure. Patients with locally recurrent esophageal cancer after radical radiotherapy are the treatment regimens. The selection is limited, mainly for surgical treatment or palliative chemotherapy, and recourse radiotherapy in some head and neck malignant tumors is proved to be effective, while the literature on recourse radiotherapy for esophageal cancer is less, and the feasibility and effectiveness of radiotherapy for recurrent patients after radical radiotherapy are still in dispute. The short term effect, adverse reaction and the survival period after recurrent radiotherapy after radical radiotherapy for patients with carcinoma of tube, the factors affecting the survival prognosis of the patients and the feasibility and clinical value of re radiotherapy for esophageal cancer were evaluated comprehensively. Methods CR or PR after radical radiotherapy or radiotherapy were reviewed. 6 months after the treatment, the clinical data of 52 cases of esophageal squamous cell carcinoma with recurrent radiotherapy or radiotherapy and radiotherapy were divided into 24 cases of re-RT group and 28 cases of radiotherapy combined with chemotherapy (RCT). And the relationship between the clinicopathological factors and the survival prognosis was analyzed. The clinical value of recourse radiotherapy for recurrent esophageal cancer after radical radiotherapy was evaluated. IBM SPSS Statistics 19 statistical software was used for statistical processing. The general data, the comparison of the curative effect and the incidence of adverse reaction were compared with the chi square test and the use of Kaplan-Meier The survival curves of the patients in the whole group and the subgroups were made and the significant level of the survival rate difference was tested by log-rank test. The Cox proportional risk model was used to carry out the single factor and multifactor analysis related to the recurrence of the survival period. All the test statistics were set as P0.05. 10 cases (19.2%), 26 cases (50%), 13 cases (25%) of SD, 3 cases (5.8%) of PD, 36 (69.2%).RCT group in CR+PR (69.2%).RCT group (71.4%) was slightly higher than that of re-RT group (58.3%), but the difference was not statistically significant (p=0.331). There were 9 cases (17.3%) with acute radiation pneumonitis, 3 cases in group re-RT (12.5%), 6 cases in group RCT (21.4%), 21 (40.4%) in 2-3 degree myelosuppressor, 1 in group re-RT (4.2%), 3 in group RCT, 3 in radiotherapy or after radiotherapy, in group RCT, re-RT group, RCT group, except bone marrow The incidence of inhibition in the RCT group was significantly higher than that in the re-RT group. There was no significant difference in the incidence of adverse reactions among the other two groups. The 52 patients in the whole group had a 11 month survival period (95%CI 9.380-12.630), the 1 year survival rate was 44.2%, the 2 year survival rate was 11.5%, and the 3 year survival rate was 3.8%. single factor analysis for 1 years for the recurrence interval of 1 years. P=0.000, PS score 0-1 (p=0.000), RRT combined with chemotherapy (p=0.045) and the recurrence of g50Gy (p=0.000) in re radiotherapy were relatively good for the survival prognosis. Multivariate analysis showed that the PS score of the patients and the combined chemotherapy of re radiotherapy were independent factors affecting the prognosis of the patients. The PS score was 0-1 in 43, with a median survival period of 13 months and 53.5% for 1 years, 9 with a PS score of 2-3, a median survival of 8 months, and 24 for re-RT in the 1 year survival rate of 11.1%., the median survival time was 9 months, the 1 year survival rate was 37.5%; The 2 month, 1 year survival rate is 50.0%. conclusion for some patients with locally recurrent esophageal cancer after radical radiotherapy. Reprocess radiotherapy is feasible. It can effectively control the progression of the disease and improve the survival prognosis. The prognosis and interval time of the patients, the PS score in the recourse radiotherapy, the dose of the re course radiotherapy, and the combination of the re radiotherapy. Chemotherapy is associated with a recurrent PS score of 0-1 and a recurrent interval of more than 1 years. "G50Gy combined with chemotherapy can improve survival prognosis. But the incidence of adverse reactions is significantly higher than the risk of severe complications such as high first course radiotherapy and perforation. Evaluation before radiotherapy.
【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R735.1

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