Prasad N R Vishnu, Karthigeyan M, Vikram Kate, Parthasarathy R, Reddy K S
Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, 605006 India.
Department of Radiotherapy, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, 605006 India.
Indian J Surg. 2015 Feb;77(1):34-8. doi: 10.1007/s12262-013-0817-4. Epub 2013 Jan 26.
The present study was undertaken to evaluate the efficacy of radiotherapy in palliation of dysphagia in patients with squamous cell carcinoma (SCC) of esophagus and to see the quality of life (QoL) following radiotherapy. This was a prospective clinical study done between September 2006 and May 2008. All consecutive patients with SCC of the esophagus, who are not candidates for definitive treatment, were included in the study. Dysphagia and QoL were assessed using modified Takita's grading and modified questionnaire based on EORTC QLQ 30 respectively. External beam radiotherapy (EBRT) was delivered to all patients using linear accelerator 6 Mv photons. Patients who had good response with EBRT were further subjected to intraluminal brachytherapy (ILBT) at 700 cGy using Iridium-192. The cumulative dose each patient received was 65 Gy. Patients were followed up at 6 weeks from completion of treatment to look for any difference in dysphagia grade and QoL following therapy. Thirty-three patients were included in the study. The mean age among males and females was 60.9 and 49.8 years, respectively. Nineteen patients (57.6 %) received EBRT followed by ILBT; the remaining patients received only EBRT. Seven were lost during follow-up, and seven (21.2 %) died during the study period of 6 weeks. Nineteen (57.6 %) were followed up. On follow-up endoscopy, evidence of residual stricture was observed in 57.9 %, and growth in 36.8 %. Of the patients, 27.8 % had biopsy-confirmed residual disease. The median dysphagia score decreased from 4 to 3 after treatment (p = 0.002) in 17 (89.5 %) patients. The mean QoL score improved from 107.5 to 114.1 at 6-week follow-up. Following radiotherapy, 26.3 % had persistent chest pain, increased cough with expectoration in 15.8 %, and hyperpigmentation of skin in 10.5 %. Radiotherapy gives significant relief of dysphagia and improves QoL in 90 % of patients with SCC of esophagus. However, following radiotherapy, a number of patients will have persistent stricture, ulceration, and residual disease.
本研究旨在评估放射治疗对食管鳞状细胞癌（SCC）患者吞咽困难的缓解疗效，并观察放疗后的生活质量（QoL）。这是一项于2006年9月至2008年5月期间进行的前瞻性临床研究。所有连续的、不适合进行根治性治疗的食管SCC患者均纳入本研究。分别使用改良的泷田分级和基于欧洲癌症研究与治疗组织（EORTC）QLQ 30的改良问卷对吞咽困难和生活质量进行评估。所有患者均使用直线加速器6 Mv光子进行外照射放疗（EBRT）。对EBRT反应良好的患者进一步接受使用铱-192的腔内近距离放疗（ILBT），剂量为700 cGy。每位患者接受的累积剂量为65 Gy。治疗结束后6周对患者进行随访，以观察治疗后吞咽困难分级和生活质量的任何差异。33例患者纳入本研究。男性和女性的平均年龄分别为60.9岁和49.8岁。19例患者（57.6%）接受了EBRT后再行ILBT；其余患者仅接受EBRT。7例在随访期间失访，7例（21.2%）在6周的研究期间死亡。19例（57.6%）患者完成随访。随访内镜检查发现，57.9%的患者有残余狭窄迹象，36.8%有肿瘤生长。27.8%的患者经活检证实有残余疾病。17例（89.5%）患者治疗后吞咽困难中位数评分从4降至3（p = 0.002）。6周随访时生活质量平均评分从107.5提高到114.1。放疗后，26.3%的患者有持续性胸痛，15.8%的患者咳嗽伴咳痰增多，10.5%的患者皮肤色素沉着。放疗能显著缓解食管SCC患者90%的吞咽困难并改善生活质量。然而，放疗后，许多患者会有持续性狭窄、溃疡和残余疾病。
