Wieland C, Hymmen U
Strahlentherapie. 1977 Nov;153(11):719-25.
Results from radiotherapeutic treatment of 200 patients with malignant tumors of the esophagus are reported. The principal part is represented by squamous cell carcinomas with 88%, followed by adenocarcinomas with 4.5%, by more or less differentiated solid carcinomas with 4%, and small cell carcinomas with 1.5%. Sarcoma was found in three cases, one of them a myosarcoma, another a reticulosarcoma. An ectopic carcinoma of the gastric glands was present in one case. The staging was performed according to the TNM system. A focal dose of 6000 to 6500 rd within 6 or 8 weeks was tried for, using 60Co-gamma-rays. The one-year and five-year survival rates in stage T2N0M0 amounted to 80% and to 17%; no survival was obtained in stage T3N0M0. Out of the total of stage T2-3N0M0 cases 24% obtained one-year survival, and 2% five-year survival. In stages T3N2-3M0 and T3Nx-3M1 after one year 9% and 7% of the patients were alive. The mean survival time of stage T2N0M0 cases was 30.5 months; of T3N0M0, 7.3 months; of T3N1-3M0, 5.2 months; of T3Nx-3M1, 3.8 months. The one-year and five-year survival rates, being related to the irradiation dose administered, amounted to 28% and to 2% after a minimum dose of 5000 rd to the focus. With less than 5000 rd, none of the patients survived two years. The bad results of treatment demand new therapeutic pathways. Short-term pre-irradiation followed by surgical treatment is discussed as well as a combined radiation therapy with cobalt-60 and neutrons or a combined radio-chemotherapy using cytostatics.
报告了200例食管癌患者放射治疗的结果。主要部分为鳞状细胞癌,占88%,其次是腺癌,占4.5%,低分化或高分化实体癌占4%,小细胞癌占1.5%。发现3例肉瘤,其中1例为平滑肌肉瘤,另1例为网状细胞肉瘤。1例存在胃腺异位癌。根据TNM系统进行分期。使用60钴γ射线,尝试在6或8周内给予瘤灶6000至6500拉德的局部剂量。T2N0M0期的1年和5年生存率分别为80%和17%;T3N0M0期无生存病例。在T2 - 3N0M0期的所有病例中,24%获得1年生存,2%获得5年生存。在T3N2 - 3M0期和T3Nx - 3M1期,1年后分别有9%和7%的患者存活。T2N0M0期病例的平均生存时间为30.5个月;T3N0M0期为7.3个月;T3N1 - 3M0期为5.2个月;T3Nx - 3M1期为3.8个月。与所给予的照射剂量相关的1年和5年生存率,在瘤灶接受最低5000拉德剂量后分别为28%和2%。剂量低于5000拉德时,无患者存活两年。治疗效果不佳需要新的治疗途径。讨论了短期放疗后手术治疗,以及钴 - 60与中子联合放疗或使用细胞抑制剂的联合放化疗。