Unger E C, Coia L, Gatenby R, Kessler H, Hartz W, Clair M, Broder G
Department of Radiology, University of Arizona Health Science Center, Tucson 85724.
J Comput Assist Tomogr. 1992 Mar-Apr;16(2):235-9. doi: 10.1097/00004728-199203000-00011.
Primary radiation therapy with concurrent chemotherapy is under study as definitive and palliative therapy for patients with esophageal carcinoma. To evaluate the correlation between CT staging and outcome, we retrospectively reviewed the CT scans of 48 patients treated with primary radiation therapy and concurrent chemotherapy and correlated CT staging with disease-free survival, overall survival, and site of relapse. Excluding one patient who was understaged and six patients who died of problems unrelated to esophageal carcinoma, mean survival of CT stage I, II, and III patients was 14.7, 21.3, and 5.2 months, respectively. When the CT stage is modified by the presence of nodal involvement on CT, the mean survival of stage IIn and IIIn (nodes greater than 1.5 cm in diameter) and stage IV patients (distant metastases) was 16.4, 19.2, and 10.6 months, respectively. Despite thickening of the esophageal wall greater than 3.0 cm in five patients with stage IIn cancer, mean survival was still 19.2 months. Patients with pericardial effusion had the worst survival of only 4.3 months. Stage II patients had a significantly longer (p less than 0.05) disease-free period than all other groups and the difference between stage II and III patients was highly significant (p less than 0.01). Stage II patients were also more likely to be disease-free at the time of death or last follow-up (p less than 0.05). Computed tomographic staging of esophageal carcinoma is useful in radiation therapy treatment planning and predicting outcome of patients managed with a nonsurgical technique of concurrent radiation and chemotherapy.
同步化疗的原发性放射治疗正在作为食管癌患者的根治性和姑息性治疗进行研究。为了评估CT分期与预后之间的相关性，我们回顾性分析了48例接受原发性放射治疗和同步化疗患者的CT扫描结果，并将CT分期与无病生存期、总生存期和复发部位进行了关联。排除1例分期过低的患者和6例死于与食管癌无关问题的患者后，CT I期、II期和III期患者的平均生存期分别为14.7个月、21.3个月和5.2个月。当根据CT上有无淋巴结受累对CT分期进行修正时，IIIn期（直径大于1.5 cm的淋巴结）和IV期（远处转移）患者的平均生存期分别为16.4个月、19.2个月和10.6个月。尽管5例IIIn期癌症患者的食管壁增厚超过3.0 cm，但其平均生存期仍为19.2个月。有心包积液的患者生存期最差，仅为4.3个月。II期患者的无病期明显长于所有其他组（p<0.05），II期和III期患者之间的差异非常显著（p<0.01）。II期患者在死亡或最后一次随访时无病的可能性也更大（p<0.05）。食管癌的CT分期在放射治疗治疗计划以及预测采用同步放疗和化疗的非手术技术治疗的患者的预后方面很有用。
