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目的:回顾性分析食管癌不同临床靶体积对适形调强放射治疗疗效及失败模式的影响,探讨不进行淋巴结预防照射是否可行。方法:2007年1月至2011年6月本院收治行根治性三维适形放疗(3 dimensional conformal radiotherapy,3D-CRT)/调强放疗(intensity modulated radiation therapy,IMRT)的食管鳞状细胞癌患者共68例,根据CTV范围不同分成淋巴结累及野组(累及野组)和淋巴结扩大野组(扩大野组)。结果:累及野组和扩大野组1、2年的生存率分别为59%、41%和61%、39%(P=0.56),局部控制率分别为66%、48%和68%、49%(P=0.78)。累及野组和扩大野组总失败率分别为63%和66%(P=0.89),局部失败率为53%和59%,远处转移失败率分别为47%和44%,区域失败率分别为11.8%和7.5%,两者比较差异无统计学意义(P=0.39)。扩大野组肺V10、V20、V30及肺平均受量等指标均大于累及野组,其中V10和肺平均剂量比较差异有统计学意义。结论:累及野组在生存率、局部控制率方面和扩大野组相似,野内复发和远处转移是治疗失败的主要原因,局部晚期食管癌患者行累及野放疗是安全的。
Objective: To retrospectively analyze the influence of different clinical target volume of esophageal cancer on the efficacy and failure mode of conformal IMRT and to explore whether it is feasible to prevent lymph node irradiation. Methods: From January 2007 to June 2011, patients with esophageal squamous cell carcinoma who underwent radical 3-dimensional conformal radiotherapy (3D-CRT) / intensity modulated radiation therapy (IMRT) A total of 68 cases, divided into lymph node involvement group (involving the wild group) and lymph node expansion group (enlarged group) according to the range of CTV. RESULTS: The 1- and 2-year survival rates were 59%, 41% and 61%, 39% (P = 0.56) in the intervention group and the extended group, respectively. The local control rates were 66%, 48% and 68% % (P = 0.78). The total failure rates in the involved and extended groups were 63% and 66%, respectively (P = 0.89), with local failure rates of 53% and 59%, distant failure rates of 47% and 44%, respectively, and regional failure rates Which was 11.8% and 7.5%, respectively, with no significant difference (P = 0.39). The indexes of lung V10, V20, V30 and mean lung volume in the enlarged group were higher than those in the involved group, and the difference between V10 and the average lung dose was statistically significant. CONCLUSION: Invasive field group is similar to extended field group in survival rate and local control rate. Intra-field recurrence and distant metastasis are the main reasons for failure of treatment. Local advanced esophageal cancer patients are safe and involved in field radiotherapy.