Fok M, Sham J S, Choy D, Cheng S W, Wong J
Department of Surgery, University of Hong Kong, Queen Mary Hospital.
Surgery. 1993 Feb;113(2):138-47.
A prospective, randomized controlled study of radiotherapy after resection of esophageal carcinoma was carried out in 130 patients. Patients were stratified according to whether the resection was curative or palliative and were then randomized to receive postoperative radiotherapy or no additional treatment. Sixty patients underwent curative resection; 30 each were randomized into the radiotherapy group (CR + R) and the control group (CR). Seventy patients underwent palliative resection; 35 each were randomized into the radiotherapy group (PR + R) and the control group (PR).
No complications occurred while the patients were undergoing radiotherapy treatment. On follow-up, complications in the intrathoracic stomach occurred in 24 patients (37%) who underwent radiotherapy compared with four patients (6%) in the control group (p < 0.0001). Seventeen of these 24 patients in the radiotherapy group had gastric ulceration and there were five deaths as a result of bleeding. Local recurrence developed significantly less frequently in the PR + R group compared with the PR group (seven patients [20%] vs 16 patients [46%]; p = 0.04); no difference was observed between CR + R and CR groups (10% and 13%, respectively). Intrathoracic recurrence occurred in fewer patients in the radiotherapy groups (CR + R and PR + R) compared with the control groups (CR and PR) (four patients vs 15 patients; p = 0.01). In patients with residual tumor in the mediastinum after resection, two (7%) of 29 patients who underwent radiotherapy died of tracheobronchial obstruction, compared with nine (33%) of 27 patients in the control groups (p = 0.03). No difference in local recurrence was observed for extrathoracic or anastomotic recurrence. Distant metastasis developed in 12 patients (40%) in the CR + R group, nine patients (30%) in the CR group (p = 0.59), 24 patients (69%) in the PR + R group, and 18 patients (51%) in the PR group (p = 0.22). The time of onset of metastasis was 5.1 months for the PR + R group, which was shorter than the 8.5 months for the PR group (p = 0.05). The time of onset of metastasis was similar for the CR + R and CR groups (9.9 months and 11.0 months, respectively; p = 0.76). The overall median survival of patients after postoperative radiotherapy (CR + R and PR + R) was 8.7 months, which was shorter than the 15.2 months for the control groups (CR and PR) (p = 0.02).
The shorter survival of patients who underwent postoperative radiotherapy was the result of irradiation-related death and the early appearance of metastatic diseases. The role of postoperative radiotherapy is therefore limited to a specific group of patients with residual tumor in the mediastinum after operation, for whom radiotherapy can significantly reduce the incidence of local recurrence obstructing the tracheobronchial tree.
对130例食管癌切除术后患者进行了一项前瞻性随机对照放疗研究。患者根据切除是根治性还是姑息性进行分层，然后随机分为接受术后放疗组或不接受额外治疗组。60例患者接受了根治性切除；每组30例分别随机进入放疗组（CR + R）和对照组（CR）。70例患者接受了姑息性切除；每组35例分别随机进入放疗组（PR + R）和对照组（PR）。
患者接受放疗期间未发生并发症。随访时，接受放疗的患者中有24例（37%）发生胸内胃并发症，而对照组有4例（6%）（p < 0.0001）。放疗组的这24例患者中有17例发生胃溃疡，5例因出血死亡。与PR组相比，PR + R组局部复发的发生率显著降低（7例[20%]对16例[46%]；p = 0.04）；CR + R组与CR组之间未观察到差异（分别为10%和13%）。与对照组（CR和PR）相比，放疗组（CR + R和PR + R）胸内复发的患者较少（4例对15例；p = 0.01）。切除术后纵隔有残留肿瘤的患者中，接受放疗的29例患者中有2例（7%）死于气管支气管梗阻，而对照组27例患者中有9例（33%）（p = 0.03）。胸外或吻合口复发的局部复发情况未观察到差异。CR + R组有12例患者（40%）发生远处转移，CR组有9例患者（30%）（p = 0.59），PR + R组有24例患者（69%），PR组有18例患者（51%）（p = 0.22）。PR + R组转移发生时间为5.1个月，短于PR组的8.5个月（p = 0.05）。CR + R组与CR组转移发生时间相似（分别为9.9个月和11.0个月；p = 0.76）。术后放疗组（CR + R和PR + R）患者的总中位生存期为8.7个月，短于对照组（CR和PR）的15.2个月（p = 0.02）。
接受术后放疗患者生存期较短是放疗相关死亡和转移性疾病早期出现的结果。因此，术后放疗的作用仅限于特定的一组术后纵隔有残留肿瘤的患者，对他们而言，放疗可显著降低阻塞气管支气管树的局部复发发生率。
