目的 探讨食管癌术后纵隔淋巴结转移中大体肿瘤体积(GTV)>40 cm3患者对同步放化疗的疗效.方法 选择本院2010年6月至2012年11月经筛查出现纵隔淋巴结转移且GTV>40 cm3的食管癌术后患者60例,随机接受单纯三维适形放疗(对照组,30例)或同步化疗联合三维适形放疗(治疗组,30例);两组放疗均采用6MV X线照射,单次量为2.0 Gy/次,1次/天,5次/周,总剂量60~64 Gy,而治疗组在三维适形放疗的基础上接受紫杉醇+顺铂(TP)方案.治疗结束1个月后采用RECIST 1.1版标准评价客观疗效,采用RTOG标准评价不良反应,同时随访其生存情况.结果 所有患者均可评价疗效.治疗组的有效率(RR)和疾病控制率(DCR)分别为86.7%和100.0%,而对照组分别为60.0%和96.7%,治疗组的RR高于对照组(P<0.05),但两组DCR的差异无统计学意义(P>0.05);治疗组与对照组的中位生存期分别为27.0个月和22.0个月,差异有统计学意义(P<0.05);治疗组的1、2、3年生存率分别为90.0%、53.3%和26.7%,而对照组分别为73.3%、23.3%和6.7%,两组3年生存率的差异有统计学意义(P<0.05).全组的不良反应主要为放射性气管炎、放射性肺炎、胃肠道反应和骨髓抑制,均为1~2级,无3~4级不良反应发生.两组不良反应的差异无统计学意义(P>0.05).结论 同步放化疗可提高食管癌术后纵隔淋巴结转移中GTV>40 cm3者的局部控制率及生存率,不良反应小,患者可耐受.%Objective To evaluate the influence of gross tumor volume( GTV) >40 cm3 of mediastinal lymph nodes on the curative effect of patients with esophageal cancer receiving concurrent chemoradiotherapy after esophagectomy. Methods From June 2010 to November 2012, sixty patients with GTV >40 cm3 of mediastinal lymph nodes were randomly assigned to receive three dimen-sional conformal radiotherapy ( control group, n=30) and concurrent chemoradiotherapy ( treatment group, n=30) . As for radiothera-py, the total radiation dose was 60-64 Gy at a fraction of 2 Gy with 5 f/week. Treatment group received paclitaxel and cisplatin (TP) regime additionally. Response to chemotherapy was assessed by RECIST criteria 1. 1 and toxicity was evaluated according to RGOT standard. The clinical follow-up data from chemotherapy were investigated. Results All patients were available for evaluation. The total response rate ( RR) and disease control rate ( DCR) were 86. 7% and 100. 0% in treatment group, and 60. 0% and 96. 7% in control group. The RR of treatment group was higher than that of control group ( P<0. 05) . No significant difference was observed on DCR between both groups ( P>0. 05) . The median overall survival of the treatment group and the control group were 27. 0 months and 22. 0 months, respectively, and the difference was statistically significant ( P<0. 05 ) . The 1-, 2- and 3-year survival rates were 90. 0%, 53. 3% and 26. 7% in treatment group and 73. 3%, 23. 3% and 6. 7% in control group, respectively. The difference of 3-year survival rate between both groups was statistically significance ( P<0. 05) . The adverse reactions of the whole group were mainly of ra-dioactive esophagitis, radiation pneumonia, gastrointestinal reaction and bone marrow suppression, all of which were 1-2 grade, and there was no 3-4 grade adverse reaction. There was no significant difference in adverse reactions between both groups ( P>0. 05) . Con-clusion Concurrent chemoradiotherapy improved the local control rate and survival rate for GTV>40 cm3 of mediastinal lymph node metastasis after esophagectomy with mild and tolerated adverse reaction.
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