Nemoto K, Ariga H, Kakuto Y, Matsushita H, Takeda K, Takahashi C, Takai Y, Yamada S, Hosoi Y
Department of Radiology, Tohoku University School of Medicine, Seiryo-machi 1-1, Aoba-ku, Sendai 980-8574, Japan.
Radiother Oncol. 2001 Nov;61(2):165-8. doi: 10.1016/s0167-8140(01)00392-9.
To evaluate the treatment outcome of radiation therapy for 33 loco-regionally recurrent esophageal cancer patients.
Between 1988 and 1997, 33 patients with loco-regional recurrence of esophageal cancer after curative surgery received radiation therapy at an average total dose of 61 Gy. The site of recurrence was the supraclavicular region in 14 patients, the mediastinal region in 13 patients, and both the supraclavicular and mediastinal regions in six patients. If patients had ether distant metastasis or malignant pleural effusion, they were excluded from analysis. Patients who received prophylactic postoperative irradiation were also excluded from analysis.
The median survival period was 7 months. The survival rates at 1, 2, and 3 years were 33, 15, and 12%, respectively. In univariate analysis, patients with a short time interval between surgery and recurrence (P=0.0098) and patients with recurrence in both the supraclavicular and mediastinal regions (P=0.036) had a worse prognosis. In multivariate analysis, the time interval between surgery and recurrence (P<0.001) and age (worse prognosis in younger patients, P=0.019) were the significant prognostic factors. Complete or partial responses were observed in nine (27%) and 21 (64%) of the patients, respectively. Changes in clinical symptoms, such as dysphagia, chest pain and back pain, could be evaluated in 11 patients, and improvement in symptoms was obtained in eight (73%) patients.
The prognosis of patients who received radiation therapy for postoperative loco-regional recurrence of esophageal cancer is poor. However, there is symptomatic relief in a significant proportion of such patients, and long-term survival is possible in some patients.
评估33例局部区域复发性食管癌患者的放射治疗效果。
1988年至1997年间，33例食管癌根治术后局部区域复发的患者接受了放射治疗，平均总剂量为61 Gy。复发部位为锁骨上区14例，纵隔区13例，锁骨上区和纵隔区均复发6例。若患者有远处转移或恶性胸腔积液，则排除在分析之外。接受术后预防性放疗的患者也排除在分析之外。
中位生存期为7个月。1年、2年和3年生存率分别为33%、15%和12%。单因素分析显示，手术与复发间隔时间短的患者（P=0.0098）以及锁骨上区和纵隔区均复发的患者（P=0.036）预后较差。多因素分析显示，手术与复发间隔时间（P<0.001）和年龄（年轻患者预后较差，P=0.019）是显著的预后因素。分别有9例（27%）和21例（64%）患者观察到完全缓解或部分缓解。11例患者可评估吞咽困难、胸痛和背痛等临床症状的变化，其中8例（73%）患者症状得到改善。
食管癌术后局部区域复发接受放射治疗的患者预后较差。然而，相当一部分此类患者有症状缓解，部分患者可能长期存活。
