作者：段有升1，张丽娜1，沈文斌2

单位：1.新疆巴州人民医院 放疗科， 新疆 库尔勒 841000; 2.河北医科大学第四医院, 河北 石家庄 050000

Authors: Duan Yousheng1，Zhang Lina1，Shen Wenbin2

Unit: 1.Department of Radiotherapy，Bazhou People's Hospital，Korla 841000，Xinjiang，China; 2.The Fourth Hospital of Hebei Medical University，Shijiazhuang 050000，Hebei，China

摘要：

目的 探讨不同放疗模式对食管癌患者根治性放疗后放射性损伤和远期生存的影响。方法 选取2017年6月至2019年6月在新疆巴州人民医院和河北医科大学第四医院接受根治性放疗的食管癌患者161例，将纳入研究的食管癌患者按不同放疗模式分为选择性淋巴引流区照射(ENI)组和累及野照射(IFI)组，采用t检验或χ2检验比较两组患者年龄、性别、体重指数、病理类型等一般临床资料，采用χ2检验比较两组患者放射性损伤的发生率，绘制两组患者根治性放疗后3年的生存情况的Kaplan-Meier生存曲线，比较两组患者根治性放疗后3年的肿瘤局部控制率、无病生存率以及总生存率。结果 研究共纳入接受根治性放疗的食管癌患者161例，其中男103例(63.9%)，女58例(36.1%)，年龄32～74岁，平均年龄(55.1±13.4)岁，中位年龄57岁，平均体重指数(22.3±3.1)kg/m2。所有患者按不同放疗模式分为ENI组98例(60.9%)和IFI组63例(39.1%)，两组患者一般临床病理资料组间比较差异无统计学意义。ENI组患者放射性食管炎的发生率(59.2%)高于IFI组患者(44.4%)(P=0.043),161例食管癌患者根治性放疗后1年、3年、5年肿瘤局部控制率分别为81.6%、65.4%、45.5%，无病生存率分别为65.4%、40.2%、26.7%，总生存率分别为82.3%、75.8%、61.4%。Kaplan-Meier生存分析显示，ENI组患者根治性放疗后1年、2年、3年肿瘤局部控制率、无病生存率以及总生存率高于IFI组患者(P=0.035,0.032,0.049)。结论 IFI模式能相对减少放射性食管炎的发生风险，但ENI模式可以提高患者的肿瘤局部控制率，使患者生存获益。 

关键词：食管癌； 根治性放疗； 放射性损伤； 远期生存

Abstract：

Objective To investigate the effects of different radiotherapy modes on radiation injury and long-term survival of patients with esophageal cancer after radical radiotherapy. Method From June 2017 to June 2019，161 patients with esophageal cancer who received radical radiotherapy in Xinjiang Bazhou People's Hospital and the Fourth Hospital of Hebei Medical University were divided into selective lymphatic drainage area irradiation（ENI） group and involved field irradiation（IFI） group. T-test or χ2 test was used to compare the general clinical data of the two groups，such as age，sex，body mass index，pathological type and so on. The incidence of radiation injury in the two groups was compared by χ2 test，and the Kaplan-Meier survival curves of the two groups were drawn 3 years after radical radiotherapy. The tumor local control rate，disease-free survival rate and overall survival rate of the two groups were compared. Result The local control rate，disease-free survival rate and overall survival rate of the two groups were compared 3 years after radical radiotherapy. Result A total of 161 patients with esophageal cancer were enrolled in the study，including 103 males（63.9%） and 58 females（36.1%）， aged 32 to 74 years， mean age（55.1 ±13.4） years， median age 57 years， mean body mass index（BMI）（22.3±3.1）kg/m2. all patients were divided into ENI group（n=98） and IFI group（n=63） according to different radiotherapy modes. There was no significant difference in general clinicopathological data between the two groups. The incidence of radiation esophagitis in ENI group （59.2%） was higher than that in IFI group（44.4%）（P=0.043）. The tumor local control rates at 1 year， 3 years and 5 years after radical radiotherapy were 81.6%，65.4% and 45.5%， respectively， and the disease-free survival rates were 65.4%，40.2% and 26.7%，respectively. The overall survival rates were 82.3%， 75.8% and 61.4%，respectively. The tumor local control rate， disease-free survival rate and overall survival rate in the ENI group were higher than those in the IFI group at 1， 2 and 3 years after radical radiotherapy（P=0.035，0.032，0.049）. Conclusion IFI mode can relatively reduce the risk of radiation esophagitis， but ENI mode can improve the local tumor control rate of esophageal cancer patients， and benefit the survival of patients.

Key Words: Esophageal cancer; Radical radiotherapy; Radiation injury; Long-term survival