發(fā)布時(shí)間：2018-06-09 04:36

  本文選題：食管癌 + 累及野照射��； 參考：《浙江大學(xué)》2015年碩士論文

【摘要】：目的：比較根治性單純放療的老年食管鱗癌患者行淋巴結(jié)累及野照射(IFI)和預(yù)防性照射(ENI)的治療效果和不良反應(yīng),從而探討老年患者單純放療行淋巴結(jié)累及野照射的可行性。材料和方法：收集2007-2010年期間兩中心經(jīng)病理證實(shí)的大于70歲的老年食管鱗癌患者共79例,均行單純根治性調(diào)強(qiáng)放射治療。其中48例進(jìn)行IFI放療,31例進(jìn)行ENI放療。IFI組大體腫瘤靶體積(GTV)包括轉(zhuǎn)移淋巴結(jié)及食管原發(fā)灶,臨床靶體積(CTV)為陽(yáng)性淋巴結(jié)外擴(kuò)0.5-0.8cm,食管病灶前后左右外擴(kuò)0.5-0.8cm,上、下擴(kuò)3cm；ENI組GTV同IFI組,CTV1同IFI組CTV, CTV2包括預(yù)防照射的淋巴引流區(qū),PTV為CTV外放0.5cm,處方劑量?jī)山M均為54-71Gy。中位隨訪時(shí)間為24個(gè)月,比較兩組的疾病無(wú)進(jìn)展生存率,總生存率,治療失敗模式及肺照射劑量及放射性肺炎發(fā)生率。結(jié)果：1,2,3年疾病無(wú)進(jìn)展生存率,IFI組為60.4%,34.9%,29.7%,ENI組為64.5%,54.0%,35.0%,兩者無(wú)進(jìn)展生存率比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)；1,2,3年總生存率IFI組為72.9%,43.4%,31.5%,ENI組為73.0%,53.0%,38.3%,中位生存期兩組分別為25和28個(gè)月,ENI組有生存提高趨勢(shì),但兩者差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。兩組的失敗模式類似,遠(yuǎn)處轉(zhuǎn)移、局部復(fù)發(fā)、非受累野淋巴結(jié)復(fù)發(fā)率IFI組及ENI組分別為22.9%,27.0%,4.2%和25.8%,19.4%,0%,兩組比較差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。在治療相關(guān)不良反應(yīng)方面,ENI組中肺V5、V20、肺平均劑量等指標(biāo)均大于IFI組,比較差異均有統(tǒng)計(jì)學(xué)意義(t=4.66、29.90、15.63,P0.05)；放射性肺炎的發(fā)生率ENI組明顯高于IFI組,1-2級(jí)分別為22%和13%,3級(jí)分別為19%和4%,兩組比較差異有統(tǒng)計(jì)學(xué)意義(χ2=4.55、4.77,P0.05)。結(jié)論：在老年食管鱗癌單純放療患者中,IFI與ENI的無(wú)進(jìn)展生存率和生存率類似,但前者的肺受照射劑量明顯減少,減少了老年人的肺損傷,是較為合適的治療方法。
[Abstract]:Objective: to compare the therapeutic effects and side effects of lymph node involvement (IFI) and prophylactic irradiation (ENI) in elderly patients with esophageal squamous cell carcinoma treated by radical radiotherapy alone, and to explore the feasibility of radiotherapy alone in elderly patients with lymph node involvement. Materials and methods: 79 patients with esophageal squamous cell carcinoma over 70 years old confirmed by pathology from 2007 to 2010 were treated with simple radical intensity modulated radiation therapy. Among them, 48 cases were treated with IFI radiotherapy and 31 cases were treated with ENI radiotherapy. The gross tumor target volume (GTV) including metastatic lymph nodes and primary esophageal lesions was found in ENI radiotherapy. CTV (clinical target volume) was 0.5-0.8 cm in positive lymph nodes and 0.5-0.8 cm in anterior and posterior esophageal lesions. The CTV of CTV2 including the lymphoid drainage area of prevention irradiation was 0.5 cm in GTV group and CTV 1 group in IFI group, and the prescription dose was 54-71 GY in both groups. The median follow-up time was 24 months. The disease progression free survival rate, overall survival rate, failure mode of treatment, lung irradiation dose and incidence of radiation pneumonia were compared between the two groups. Results the 3 year progression free survival rate was 60.4 in the IFI group and 64.54.0 in the IFI group. There was no significant difference in the progressive survival rate between the two groups. The overall 3-year survival rate in the IFI group was 72.943.41.5ENI and 73.03.038.3in the IFI group. The survival period in the middle position group was 25 months and 28 months respectively. However, there was no significant difference between the two groups (P 0.05). The failure pattern of the two groups was similar, distant metastasis, local recurrence, non-involved field lymph node recurrence rate in IFI group and ENI group were 22.90.0.02% and 25.8%, respectively. There was no significant difference between the two groups (P 0.05). In the treatment of related adverse reactions, the lung V5V 20 and the average lung dose in the ENI group were higher than those in the IFI group. The incidence of radiation pneumonia in ENI group was significantly higher than that in IFI group (22% and 13%, 19% and 4%, respectively). The difference between the two groups was statistically significant (蠂 24.54.77 P 0.05). Conclusion: the progression-free survival rate and survival rate of IFI and ENI in elderly patients with esophageal squamous cell carcinoma treated by radiotherapy alone are similar, but the dose of lung irradiation in the former is significantly reduced and the lung injury in the elderly is reduced.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R735.1

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本文編號(hào)：1998946