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目的比较和分析食管癌术后预防性放疗中照射野范围大小对生存率的影响。方法对102例食管癌根治术后放疗50～60Gy病例进行分析,大野组(43例)照射范围为双锁骨上区、全纵隔、吻合口及胃左区；小野组(59例)照射范围根据病变部位不同而不同：胸上段食管癌为食管瘤床、双侧锁骨上区、上中纵隔,胸中段食管癌患者为食管瘤床上下各扩大5cm及纵隔淋巴结引流区(不包括胃左区),胸下段食管癌包括瘤床、隆突下淋巴结区及胃左淋巴结区。结果全部病例1、3、5年生存率分别为76%、51%、43%,中位生存期为30个月。大野组1、3、5年生存率分别为77%、52%、41%,小野组的分别为76%、49%、45%(P=0．884)。多因素分析显示,N分期、淋巴结转移数目及病变长度是影响预后的独立因素。结论食管癌根治术后预防照射时,适当缩小照射野不会降低生存率。
Objective To compare and analyze the effect of radiation field size on the survival rate of patients undergoing esophagectomy after radiotherapy. Methods 102 cases of esophageal cancer after radiotherapy 50 ~ 60Gy cases were analyzed, Ohno group (43 cases) were double supraclavicular area, the mediastinum, anastomosis and left gastric area; Ono group (59 cases) irradiation range according to Esophageal cancer of upper thoracic esophageal cancer bed, bilateral supraclavicular region, upper mediastinum, mid thoracic esophageal cancer patients to expand the upper and lower 5cm of esophageal and mediastinal lymph node drainage area (not including the left gastric area) , Lower thoracic esophageal cancer, including the tumor bed, subglottic lymph node area and left gastric lymph node area. Results The 1, 3, 5-year survival rates of all cases were 76%, 51% and 43%, respectively. The median survival time was 30 months. The 1, 3, 5-year survival rates of Ono group were 77%, 52% and 41% respectively, compared with 76%, 49% and 45% in Ono group (P = 0.884). Multivariate analysis showed that N stage, the number of lymph node metastasis and the length of the lesion were independent prognostic factors. Conclusion Radiation therapy in esophageal cancer should not reduce the survival rate when radiation is prevented.