食管癌個(gè)體化放射治療選擇性淋巴結(jié)區(qū)照射的價(jià)值課件

1、食管癌個(gè)體化放射治療選擇性淋巴結(jié)區(qū)照射的價(jià)值食管癌個(gè)體化放射治療選擇性淋巴結(jié)區(qū)照射的價(jià)值食管癌個(gè)體化放射治療選擇性淋巴結(jié)區(qū)照射的價(jià)值 國內(nèi)食管癌照射范圍 局部照射野 傳統(tǒng)野 鋇片腫瘤部位、病變長(zhǎng)度和食管軸向 常規(guī)野 鋇片所見加CT掃描 根據(jù)腫瘤實(shí)際范圍 三維立體適形照射野(不規(guī)則野) 精確放療調(diào)強(qiáng)照射野(多子野疊加，同期推量預(yù)防和治療) 圖像引導(dǎo)生物信息調(diào)強(qiáng)(靶區(qū)內(nèi)劑量的不均勻化)2由于本人工作能力和接觸項(xiàng)目有限，希望借此機(jī)會(huì)將自己的體會(huì)與大家分享，更希望大家能提出更多更為深刻的意見! 謝謝食管癌個(gè)體化放射治療選擇性淋巴結(jié)區(qū)照射的價(jià)值食管癌個(gè)體化放射 國內(nèi)食管癌照射范圍 局部照射野 傳統(tǒng)野 鋇

2、片腫瘤部位、病變長(zhǎng)度和食管軸向 常規(guī)野 鋇片所見加CT掃描 根據(jù)腫瘤實(shí)際范圍 三維立體適形照射野(不規(guī)則野) 精確放療調(diào)強(qiáng)照射野(多子野疊加，同期推量預(yù)防和治療) 圖像引導(dǎo)生物信息調(diào)強(qiáng)(靶區(qū)內(nèi)劑量的不均勻化)2 國內(nèi)食管癌照射范圍 局部照射野2照射野的具體范圍與勾畫 RTOG 85-01 (鱗癌占82%)放化組 鎖骨上區(qū)到食管胃結(jié)合部 （下1/3段食管癌不照射鎖骨上區(qū)) 30Gy/15F后縮野到原腫瘤上下各 外放5cm再加20Gy/10F 總劑量50Gy單放組 原腫瘤上下各外放5cm 達(dá)50Gy/25F （胸上、中段食管癌照射鎖骨上區(qū)) 縮野至病變上下各外放5cm 再加14Gy /7F 總劑量

3、64Gy3照射野的具體范圍與勾畫 生存或 單放組 放化療結(jié)合組首次失敗 隨機(jī)62例 隨機(jī)61例（90年前) 非隨機(jī)69例(90后) 1年生存(%) 34% (21/62) 52%(32/61) 62%(43/69)3年生存(%) 0 30%(18/61) 18%(26/69)5年生存(%) 0 26%(14/61) 14%(10/69)中位生存 12.2個(gè)月 14.1個(gè)月 16.7個(gè)月疾病未控率(%) 37%(23/62) 25%(15/61) 28%(19/69)局部區(qū)域失敗(%) 16%(10/62) 13%(8/61) 20%(14/69)單純遠(yuǎn)轉(zhuǎn)移(%) 15%( 6/62) 8%(5

4、/61) 16%(11/69)局部+區(qū)域+遠(yuǎn)轉(zhuǎn)(%) 15%(9/62) 8%(5/61) 10%(7/69)照射野的具體范圍與結(jié)果RTOG 85-01長(zhǎng)期結(jié)果4 生存或 單放組 低劑量組 腫瘤上下外放5cm、前后左右外放2cm照射 50.4 Gy （頸段癌包鎖骨上區(qū)，電子線補(bǔ)量 下段包腹腔干淋巴結(jié)區(qū)）高劑量組 前程同上達(dá)50.4Gy 后程縮野后為腫瘤上下各外放2cm 前后左右外放仍為2cm 總劑量64.8Gy 照射野的具體范圍與勾畫 RTOG 94-05 （二維放療）5低劑量組 腫瘤上下外放5cm、前后左右外放2cm照射 50.照射野的具體范圍與結(jié)果218例可供分析，高、低劑量組各109例，

5、鱗癌占87%和84%中位隨訪16.4個(gè)月，生存者中位隨訪29.5個(gè)月治療相關(guān)死亡高劑量組和低組分別為10%(11 例) 和2%11例死亡者中，7例發(fā)生在50.4Gy過程中 3例在高劑量加量中 1例在結(jié)束64.8Gy后9個(gè)月瘺形成RTOG 94-05 長(zhǎng)期結(jié)果 高劑量組109例 低劑量組109例中位生存期 13.0個(gè)月 18.1個(gè)月2年生存率 39% 40%局部區(qū)域失敗+未控 50% 55%遠(yuǎn)轉(zhuǎn)移 9% 16% 全部無差別6照射野的具體范圍與結(jié)果218例可供分析，高、低劑量組各109 食管壁內(nèi)“多源性”病灶 iller 1/7的病例在主病灶2cm外可見繼發(fā)病灶 Pradoura 間隔5cm多源性

6、癌達(dá)16% Reboud 多源性食管病變達(dá)35% 淋巴結(jié)轉(zhuǎn)移 “跳躍式”轉(zhuǎn)移關(guān)于食管癌多原發(fā)的研究食管癌的生物學(xué)特點(diǎn)： “跳躍性”7關(guān)于食管癌多原發(fā)的研究食管癌的生物學(xué)特點(diǎn)： “跳躍性”752例食管癌術(shù)后亞臨床病灶分布 亞臨床病灶 單純近端 單純遠(yuǎn)端 上下兩端均有 總發(fā)生率(%)多中心起源 7例 3例 5例 15/52(28.9)重度不典型增生 11例 11例 6例 28/52(53.9)食管壁內(nèi)浸潤(rùn) 12例 10例 19例 41/52(78.9)CTV縱向外放標(biāo)準(zhǔn)探討史鴻云 祝淑釵 翟福山 中華放射腫瘤學(xué)雜志2006;15(4):280-284 852例食管癌術(shù)后亞臨床病灶分布 亞臨床病灶

7、多中心起源、壁內(nèi)浸潤(rùn)和跳躍性轉(zhuǎn)移均可發(fā)生在距主瘤部位較遠(yuǎn)的食管壁上 CTV縱向外放標(biāo)準(zhǔn)探討這也是胸外科醫(yī)生要保證手術(shù)邊界的安全性 必須要切除較長(zhǎng)的正常食管組織的主要原因馬國偉，中華腫瘤雜志，2003，25(5): 472474 史鴻云，中華放射腫瘤學(xué)雜志，2006，15(4)：280284 Nishimaki T, World J Surg, 1996,20(1):3237 Lam KY, Clinc Pathol,1996,49(2):1241299多中心起源、壁內(nèi)浸潤(rùn)和跳躍性轉(zhuǎn)移均CTV縱向外放標(biāo)準(zhǔn)探討這也食管癌生物學(xué)特點(diǎn) 淋巴結(jié)“跳躍式”轉(zhuǎn)移10食管癌生物學(xué)特點(diǎn) 淋巴結(jié)“跳躍式”轉(zhuǎn)移10

8、Details of recurrence sites after elective nodal irradiation (ENI) using 3D-conformal radiotherapy (3D-CRT) combined with chemotherapy for thoracic esophageal squamous cell carcinoma A retrospective analysis Hideomi Yamashita, Kae Okuma, Reiko Wakui, Shino Kobayashi-Shibata, Kuni Ohtomo, Keiichi Nak

9、agawa Department of Radiology, University of Tokyo Hospital, Hongo, Bunkyo-ku, Tokyo, JapanRadiotherapy and Oncology. 2011，98 ： 25526011Details of recurrence sites afDetails of recurrence sites after elective nodal irradiation (ENI) using 3D-conformal radiotherapy (3D-CRT) combined with chemotherapy

10、 for thoracic esophageal squamous cell carcinoma A retrospective analysis (Japan)2000.6-2009.7 126例鱗癌 中位年齡67歲 全部3DCRT 療前均PET 病變部位 胸上/胸中/胸下 29/53/44例 中位長(zhǎng)度7.0cm 臨床分期 T1/T2/T3/T4 28/18/54/26例 N0/N1 50/76 M0/M1a/M1b 91/5/30 / 22/31/38/35 (metastatic sites of M1b were lower cervical, supra-clavicular or

11、celiac LNs) 化療方案 all patients received chemotherapy concurrently two cycles 5-fluorouracil 800 mg/m2/day, days 14 & days 2932 nedaplatin 80 mg/m2, day 1 & day 29 同期后再2 two cycles same dose chemotherapy Radiotherapy and Oncology. 2011，98 ： 25526012Details of recurrence sites afDefinition regional LN

12、by AJCC is mediastinal and perigastric LN excluding celiac LN. Definition of M1a region is cervical LNs in the upper thoracic, none in the middle thoracic, and celiac LNs in the lower thoracic esophagus13Definition regional LN by AJCCDetails of recurrence sites after elective nodal irradiation (ENI)

13、 using 3D-conformal radiotherapy (3D-CRT) combined with chemotherapy for thoracic esophageal squamous cell carcinoma A retrospective analysis (Japan) GTV included primary tumor and LN 1 cm in short axis by CT or PET CTV was defined as the whole thoracic esophagus (from the supraclavicular fossae to

14、the esophagogastric junction) including GTV plus 5 mm margin CTV comprised up to M1a LNs and regional LNs including positive LNs PTV adding margins 510 mm to the respective CTVs Mean lung D20 Gy V20 20%. Spinal cord dose 45 Gy All patients ENI and were treated 5050.4 Gy/1.82 Gy/55.6 W 14Details of r

15、ecurrence sites af結(jié)果 治療失敗 40例 單純局部復(fù)發(fā)20例 單純遠(yuǎn)轉(zhuǎn)12例 局部+遠(yuǎn)轉(zhuǎn)8例 選擇性淋巴引流區(qū) 0例 局部失敗部位 上段失敗34%(10/29) 中段9% (5/53) 下段11% (5/44) P=0.0073(median period local recurrence 6.9 months) After CRT CR 69% (87/126) local residual tumor 31% (39/126) 失敗類型 16%(20/126) local recurrence 47%(59/126) local recurrence and/or res

16、idual tumor 15%(19/126) distant failure 38% (48/126) remained disease free Details of recurrence sites after elective nodal irradiation (ENI) using 3D-conformal radiotherapy (3D-CRT) combined with chemotherapy for thoracic esophageal squamous cell carcinoma A retrospective analysis (Japan)15結(jié)果 治療失敗

17、40例 單純局部復(fù)發(fā)20例 單Details of recurrence sites after elective nodal irradiation (ENI) using 3D-conformal radiotherapy (3D-CRT) combined with chemotherapy for thoracic esophageal squamous cell carcinoma A retrospective analysis (Japan)16Details of recurrence sites af 結(jié)果 MTS 1年 2年 3年 總生存 28.56.9M 56% 43%

18、無病生存 9.01.1M 46% 38% 33%Details of recurrence sites after elective nodal irradiation (ENI) using 3D-conformal radiotherapy (3D-CRT) combined with chemotherapy for thoracic esophageal squamous cell carcinoma A retrospective analysis (Japan) RTOG 85-0 ENI INT0123 no-ENI P valuelocal/regional failure a

19、nd/or residual tumor 46% 55% 0.052-year survival 36% 40% 0.0517 結(jié)果 Details of recurrence sites after elective nodal irradiation (ENI) using 3D-conformal radiotherapy (3D-CRT) combined with chemotherapy for thoracic esophageal squamous cell carcinoma A retrospective analysis (Japan)18Details of recur

20、rence sites aflarge radiation fields used in this study was the fundamentaladherence to the first radiation field used in RTOG 85-01 and the results of most surgical series in Japan have indicated a survival benefit of prophylactic 3-field LN dissection for SqCC in the thoracic esophagusDetails of r

21、ecurrence sites after elective nodal irradiation (ENI) using 3D-conformal radiotherapy (3D-CRT) combined with chemotherapy for thoracic esophageal squamous cell carcinoma A retrospective analysis (Japan) ConclussionThis study suggest that ENI was effective for preventing regional nodal failure in CR

22、T for esophageal SqCCmore local recurrences were detected in the upper thanin the middle and lower thoracic carcinomas19large radiation fields used inRetrospective Analysis of Outcome Differences in Preoperative Concurrent Chemoradiation With or Without Elective Nodal Irradiation for Esophageal Squa

23、mous Cell Carcinoma Feng-Ming Hsu, M.D. Jang-Ming Lee, M.D., Ph.D , Pei-Ming Huang, M.D. Chia-Chi Lin, M.D., Ph.D. Chih-Hung Hsu, M.D., Ph.D. Yu-Chieh Tsai, M.D. Yung-Chie Lee, M.D., Ph.D. Jason Chia-Hsien Cheng, M.D., Ph.DDepartment of Oncology, Department of Surgery ，National Taiwan University Hos

24、pital, National Taiwan University College of Medicine, Taipei, TaiwanInt.J. Radiat. Oncol.Biol.Physi. 2011, 81(4):59359920Retrospective Analysis of OutcRetrospective Analysis of Outcome Differences in Preoperative Concurrent Chemoradiation With or Without Elective Nodal Irradiation for Esophageal Sq

25、uamous Cell Carcinoma (Taiwan) 回顧分析118例鱗癌 1997年AJCC分期和 術(shù)前同期放化療 放療劑量中位值36Gy 后行根治性切除 ENI 73例62%（鎖骨上預(yù)防 54例和腹腔引流區(qū)預(yù)防19例） IFI 45例38% 56例 57%接受同期化療（紫杉醇+順鉑，2周期） 隨訪遠(yuǎn)處淋巴結(jié)轉(zhuǎn)移包括(M1a 和M1b) 中位隨訪期38個(gè)月材料21Retrospective Analysis of OutcRetrospective Analysis of Outcome Differences in Preoperative Concurrent Chemoradi

26、ation With or Without Elective Nodal Irradiation for Esophageal Squamous Cell Carcinoma (Taiwan) ENI組73例 IFI組45例 P值圍手術(shù)期死亡率 0.483級(jí)心肺毒副反應(yīng) 0.44M1a 3年復(fù)發(fā)率 3% 11% 0.05孤立遠(yuǎn)LNM(M1a+M1b) 10% 14% 0.293年總生存率 45% 52% 0.313年無進(jìn)展生存率 45% 43% 0.89病理淋巴結(jié)轉(zhuǎn)移系總生存的獨(dú)立影響因素 HR=1.78 P=0.045結(jié)果結(jié)論 ENI 降低了M1a復(fù)發(fā)率但未改善生存，淋巴結(jié)轉(zhuǎn)移系影響因素22

27、Retrospective Analysis of Outc Radiotherapy and Oncology. 2009,92: 266269Elective nodal irradiation (ENI) in definitive chemoradiotherapy(CRT) for squamous cell carcinoma of the thoracic esophagusMasakatsu Onozawa a, Keiji Nihei a, Satoshi Ishikura c, Keiko Minashi b, Tomonori Yano b, Manabu Muto b,

28、 Atsushi Ohtsu b, Takashi Ogino a.1999.22001.4 102例可分析的鱗癌 接受根治性放化同期 化療方案 DDP 40mg/m2 d1,d8 5-Fu 400mg/m2/d d1-5,d8-12 每5周重復(fù), 療中用2周期 療后劑量 DDP 80mg/m2 d1, 5-Fu 800mg/m2/d d1-5, 每4周重復(fù)放療方案 CT診斷LNM為長(zhǎng)徑1cm 范圍 胸上段包括鎖骨上, 胸下段包括腹腔在ENI野內(nèi) 前后兩野對(duì)穿 40Gy/20F/4W 休息2周后給予后程放療 斜野或多野 20Gy/10F/2W CTV包括原發(fā)瘤和轉(zhuǎn)移淋巴結(jié),上下外放3cm PT

29、V包括原發(fā)瘤和轉(zhuǎn)移淋巴結(jié)和區(qū)域淋巴結(jié), 放11.5cm23 Radiotherapy and Oncology. 202424所有病人中位隨訪17個(gè)月(3-62) 存活者 中位隨訪41個(gè)月(9-62)放化療后獲CR 62例占59% 其中40例生存 20例復(fù)發(fā)轉(zhuǎn)移3年總生存率43%失敗模式 局部失敗即原發(fā)瘤復(fù)發(fā)累及淋巴結(jié)復(fù)發(fā)即原有轉(zhuǎn)移的遠(yuǎn)處失敗即除原發(fā)瘤和區(qū)域LNM外選擇淋巴結(jié)復(fù)發(fā)即在 ENI野內(nèi)的 Radiotherapy and Oncology. 2009,92: 266269Elective nodal irradiation (ENI) in definitive chemoradio

30、therapy (CRT) for squamous cell carcinoma of the thoracic esophagus25所有病人中位隨訪17個(gè)月(3-62) 失敗模式 Elective nodal irradiation (ENI) in definitive chemoradiotherapy (CRT) for squamous cell carcinoma of the thoracic esophagusIn CRT for esophageal SCC ENI is effective for preventing regional nodal failureFur

31、ther evaluation of whether ENI leads to an improved overall survival is needed 結(jié) 論 Radiotherapy and Oncology. 2009,92: 26626926Elective nodal irradiation (ENElective lymph node irradiation late course accelerated hyper-fractionated radiotherapy plus concurrent cisplatin- based chemotherapy for esoph

32、ageal squamous cell carcinoma: a phase II study Dongqing Wang, Jiali Yang, Jingyu Zhu, Baosheng Li, Limin Zhai， Mingping Sun, Heyi Gong, Tao Zhou, Yumei Wei, Wei Huang, Zhongtang Wang, Hongsheng Li and Zicheng ZhangDepartment of Radiation Oncology, Shandong Cancer Hospital, Shandong Academy of Medic

33、al Sciences, Jinan, China Radiation Oncology 2013, 8:10827Elective lymph node irradiatioElective lymph node irradiation late course accelerated hyper-fractionated radiotherapy plus concurrent cisplatin based chemotherapy for esophageal squamous cell carcinoma: a phase II study2004.1-2011.11 68例AJCC分

34、期-a 食管鱗癌 回顧性分析 中位年齡63歲(40-75) KPS80 頸段/胸上/胸中/胸下 8/24/27/9/a 分期為14/32/22 比例為 20.6% 、47.1% 、32.3% 2周期以DDP基礎(chǔ)同期化療 DDP+5-Fu 20例 占29.4% DDP+Capecitabine 12例 占17.5% DDP+ pemetrexed 32例 占47.1%臨床材料28Elective lymph node irradiatioElective lymph node irradiation late course accelerated hyper-fractionated radio

35、therapy plus concurrent cisplatin based chemotherapy for esophageal squamous cell carcinoma: a phase II study放療方案GTVp+GTVn GTVp 上下各外放5cm ,軸向外放1cm 前程PTV1 GTVn 上下和軸向均外放0.8cm 高危淋巴引流區(qū)HRLNR 均勻外放0.8cm 處方劑量40Gy/20F/4W GTVp 上下各外放3cm ,軸向外放1cm 后程PTV2 GTVn 上下和軸向均外放0.8cm 不再照射高危淋巴引流區(qū)HRLNR 19.6Gy/14F/1.4W 1.4Gy/F

36、 2F/d 間隔6h 前后兩程總劑量 59.6Gy/34F/5.4W29Elective lymph node irradiatioElective lymph node irradiation late course accelerated hyper-fractionated radiotherapy plus concurrent cisplatin based chemotherapy for esophageal squamous cell carcinoma: a phase II study30Elective lymph node irradiatioElective lymp

37、h node irradiation late course accelerated hyper-fractionated radiotherapy plus concurrent cisplatin based chemotherapy for esophageal squamous cell carcinoma: a phase II study31Elective lymph node irradiatioElective lymph node irradiation late course accelerated hyper-fractionated radiotherapy plus

38、 concurrent cisplatin based chemotherapy for esophageal squamous cell carcinoma: a phase II study32Elective lymph node irradiatioElective lymph node irradiation late course accelerated hyper-fractionated radiotherapy plus concurrent cisplatin based chemotherapy for esophageal squamous cell carcinoma

39、: a phase II study33Elective lymph node irradiatioElective lymph node irradiation late course accelerated hyper-fractionated radiotherapy plus concurrent cisplatin based chemotherapy for esophageal squamous cell carcinoma: a phase II study 中位 隨訪18.5個(gè)月 中位生存34.4個(gè)月 1年 3年 5年 P值總生存率 75.5% 46.5% 22.7%期和期總

40、生存率 78.6% 49.4% 39.9% 0.671a期總生存率 68.3% 41.0% 15.4%治療結(jié)果首次失敗局部復(fù)發(fā) 20.6% 局部+區(qū)域失敗者29.4%(20/68) 區(qū)域失敗 17.6% 遠(yuǎn)處轉(zhuǎn)移 19.1%3級(jí)急性食管炎和白細(xì)胞下降 26.4%(18/68)和32.4%(22/68)3級(jí)晚期損傷：食管狹窄1例，肺纖維化1例， 5例死于晚期并發(fā)癥(消化道出血3例，瘺2例)34Elective lymph node irradiatio臨床資料1 2005.1-2010.12 食管癌患者219例接受放療 男144例,女75例,中位年齡67歲(4089 歲)2 根據(jù)是否采用淋巴引流

41、區(qū)放療分為 預(yù)防野組114例，累及野組105例 3 臨床分期采用 2009 年中國非手術(shù)治療食管 專家小組提出的 非手術(shù)治療食管癌臨床分期標(biāo)準(zhǔn) 入組條件1 病理或細(xì)胞學(xué)證實(shí)的食管癌患者 2 進(jìn)流食或半流食,卡氏評(píng)分70分 3 不合并嚴(yán)重內(nèi)科疾病 4 無食管出血、穿孔等征象 5 可行根治性放射治療初治患者 6 CT檢查未發(fā)現(xiàn)遠(yuǎn)處轉(zhuǎn)移者 食管鱗癌根治性放化療淋巴引流區(qū)預(yù)防照射的比較研究35臨床資料入組條件食管鱗癌根治性放化療淋巴引流區(qū)預(yù)防照射的比較食管鱗癌根治性放化療淋巴引流區(qū)預(yù)防照射的比較研究Upper thoracic esophagusMiddle thoracic esophagusLow

42、er thoracic esophagus 36食管鱗癌根治性放化療淋巴引流區(qū)預(yù)防照射的比較研究Upper 食管鱗癌根治性放化療淋巴引流區(qū)預(yù)防照射的比較研究GTV為增厚食管壁及陽性淋巴結(jié)CTV為GTV軸向外擴(kuò)0.5cm, 上下外擴(kuò)1.52.0cmPTV為CTV各方向外擴(kuò)0.5 1.0cmCTV1為淋巴引流區(qū)預(yù)防照射 胸上段：鎖骨上淋巴引流區(qū)、食管旁、2區(qū)、4區(qū)、5區(qū)、7區(qū) 及部分8區(qū)即隆突下3.5-4.0cm 胸中段：食管旁、2區(qū)、4區(qū)、5區(qū)、7區(qū)、8區(qū)及9區(qū)縱隔淋巴 結(jié)并包括賁門旁淋巴結(jié)或/和胃左區(qū) 胸下段：食管旁、4區(qū)、5區(qū)、7區(qū)、 8區(qū)及9區(qū)縱隔淋巴結(jié) 賁門旁淋巴結(jié)和胃左淋巴引流區(qū)或/和

43、腹主動(dòng)脈旁PTV1在 CTV1基礎(chǔ)上各外放0.5 1.0cm37食管鱗癌根治性放化療淋巴引流區(qū)預(yù)防照射的比較研究GTV為增厚食管鱗癌根治性放化療淋巴引流區(qū)預(yù)防照射的比較研究處方劑量累及野組：95%PTV 60Gy66Gy 預(yù)防野組：前程95%PTV1 46Gy52Gy 后程縮野至PTV 56Gy66Gy隨訪方式包括門診復(fù)查、電話隨訪等采用SPSS11.5進(jìn)行統(tǒng)計(jì)分析。計(jì)數(shù)資料采用2檢驗(yàn)或精確概率法。Kaplan-Meier 統(tǒng)計(jì)生存率、局控率、無遠(yuǎn)處轉(zhuǎn)移率, Log-rank 檢驗(yàn)多因素分析采用 Cox 回歸模型P0.05判定為有統(tǒng)計(jì)學(xué)意義38食管鱗癌根治性放化療淋巴引流區(qū)預(yù)防照射的比較研究處

44、方劑量隨訪食管鱗癌根治性放化療淋巴引流區(qū)預(yù)防照射的比較研究中位值（月）1-year3-year 5-year局控率2866.94%46.44%40.47%生存率2370.78%35.64%20.74%無遠(yuǎn)轉(zhuǎn)生存率-79.93%66.20%55.04% 隨訪截至2012年12月31日，中位時(shí)間23個(gè)月(282.3) 隨訪率為96.3539食管鱗癌根治性放化療淋巴引流區(qū)預(yù)防照射的比較研究中位值（月）食管鱗癌根治性放化療淋巴引流區(qū)預(yù)防照射的比較研究 臨床資料累及野組 預(yù)防野組 統(tǒng)計(jì)值 P值 姓別(例)男 66782=0.75 0.39女 3936年齡(歲)平均值 68.779.91 63.058.7

45、0 t=4.55 0.00中位值 6963原發(fā)部位(例) 頸 段 382=12.99 0.01胸上段 2245胸中段 5042胸下段 3019T分期(例) T1+2 23512=12.7 0.00T3 2015T4 6248N分期(例) N0 67622=2.00 0.16N1+2 3852TNM分期(例) 17302=3.34 0.19 2624 6260是否化療(例) 是 38462=0.40 0.53否 676840食管鱗癌根治性放化療淋巴引流區(qū)預(yù)防照射的比較研究 靶區(qū)例數(shù)中位值1年3年5年2值P值局控率IFI1052062.9739.0627.26.220.01ENI114-70.51

46、53.34 51.67生存率IFI1051967.6224.915.005.040.03ENI1142573.7145.0626.00無遠(yuǎn)轉(zhuǎn)率IFI105-76.4460.8160.810.050.83ENI114-83.0069.5152.29食管鱗癌根治性放化療淋巴引流區(qū)預(yù)防照射的比較研究41靶區(qū)例數(shù)中位值1年3年5年2值P值局控率IFI105206變量因素組別例數(shù)中位值局控率2值P值1年3年5年年齡（歲）65IFI351857.3428.9119.276.820.01ENI 62-69.3158.0354.8165IFI702465.7944.4731.131.410.24ENI 523

47、572.0047.4347.43病變部位頸+胸上段IFI252366.7843.8526.310.290.59ENI 533367.3647.7243.38中段下段IFI802061.7137.7133.007.170.01ENI 61-73.5059.1159.11T分期T1+2IFI234778.2650.4025.203.700.06ENI 51-85.9468.9165.53T3IFI202477.8238.43-0.050.83ENI 152870.5236.6236.62T4IFI621351.6434.8934.891.020.31ENI 481853.7342.4342.43影

48、響兩組局控率的各因素的分層分析42變量因素組別例數(shù)中位值局控率2值P值1年3年5年年齡（歲）變量因素組別例數(shù)中位值局控率2值P值1年3年5年N分期 TNM分期 N0 IFI672469.4941.2818.355.940.01ENI 62- 76.4758.2655.34N1+2 IFI381351.4535.0835.081.930.16ENI 523563.1051.0047.36 IFI174776.4750.53- 3.760.05ENI 30- 86.770.5165.12 IFI262579.2141.3033.010.570.30ENI 24- 78.1253.4353.43 I

49、FI621351.6439.9139.913.150.19ENI 602358.9244.7244.72GTV體積(cm3) 30 IFI212666.6732.1432.143.190.07ENI 52- 76.6358.6255.373060 IFI442466.1240.3921.541.470.23ENI 38- 67.0650.8450.8460 IFI401353.1033.9933.990.830.36IFI243561.4950.137.58化療 無 IFI672065.4340.7317.463.940.04ENI 68- 69.9153.6153.61有 IFI381858

50、.7836.5636.562.470.12IFI463871.2653.1548.72續(xù)表影響兩組局控率的各因素的分層分析43變量因素組別例數(shù)中位值局控率2值P值1年3年5年N分期 N10/5/202210/5/2022年齡65歲胸中下段N0期未化療10/3/202210/3/2022年齡65歲胸中下段N0變量因素組別例數(shù)中位值生存率2值P值1年3年5年年齡（歲）65IFI351660.0024.7518.563.390.07ENI 623777.4251.3524.7465IFI702071.4324.4612.041.410.22ENI 522376.9237.8823.14病變部位頸+胸

51、上段IFI251772.0030.0024.000.330.57ENI 533077.3648.599.82中下段IFI8020.466.2523.0211.164.020.04ENI 612570.4942.3230.20T分期T1+2IFI233491.3049.6021.260.630.43ENI 514684.3152.843.82T3IFI202075.0133.82-0.020.88ENI 152966.7038.129.52T4IFI621456.5012.3212.321.570.21ENI 481764.6233.3311.52影響兩組生存率的各因素的分層分析45變量因素組別

52、例數(shù)中位值生存率2值P值1年3年5年年齡（歲）變量 因素 組別 例數(shù) 中位值 生存率 2值 P值 1年 3年 5年 N分期 N0 IFI672474.6329.7212.396.130.01ENI 624080.6557.7829.72N1+2 IFI381655.2616.7116.711.150.28ENI 521865.3830.1322.25TNM分期 IFI173988.2451.4714.303.130.08ENI 30- 86.7073.2150.84 IFI262380.8035.6222.340.710.40ENI 243679.2148.1328.44 IFI621456.

53、5212.4312.431.130.29ENI 501565.0030.0011.22GTV體積 (cm3) 30 IFI211880.9530.2320.163.400.07ENI 525282.6956.9439.373060 IFI442170.4534.2916.530.040.84ENI 382381.5844.7418.0860 IFI401857.5011.0811.080.000.95ENI 241458.3318.759.38化療 無 IFI671970.1517.7811.432.860.10ENI 682370.5939.3728.10有 IFI382165.7935.8421.501.150.28ENI 463878.2653.320.26