同步化疗加三维适形放射治疗食管癌术后纵隔淋巴结转移

目的 探讨胸段食管癌根治术后纵隔淋巴结转移同步化疗加三维适形放射治疗的疗效和并发症。 方法 60例食管癌术后发生纵隔转移的患者，随机分为两组（适形组与对照组），每组30例，放疗采用6/15MV X线外照射，前2/3疗程常规放射治疗DT(38～40)Gy,后1/3疗程采用后程加速超分割适形放射治疗和超分割放疗,2次/天，(1.4～1.5)Gy/次，全疗程总剂量 DT(65～68)Gy，采用FP方案化疗（5-Fu+DDP）。结果 治疗后3月内复查CT,适形组与对照组的CR、PR分别为53.5%、36.7%和43.3%、36.7%，无进展病例，有效率（CR+PR）分别为90.0%、80.0% (χ²=1.17,P>0.05), 1、3、5年生存率分别为80.0%、33.3%、13.3%和73.3%、20.0% 、6.7%(χ²=0.80、1.36、0.91,P>0.05)。结论 同步化疗加三维适形放射治疗食管癌术后纵隔淋巴结转移可提高局部控制率和生存率，不良反应小。

Chemotherapy Combined with Three Dimensional Conformal Radiotherapy for Postoperative Mediastinum Lymphonode Metastasis from Esophageal Carcinoma

Objective To evaluate the treatment efficacy and complications of chemotherapy and three dimensional conformal radiotherapy (3DCRT) for mediastinum lymphonode metastasis after esophageal carcinoma operation.Methods Sixty patients with mediastinal metastasis were randomized into two groups. Thirty patients received chemotherapy and 3DCRT(3DCRT group), and the others as control group received chemotherapy and late course accelerated hyper fractionation (LCAH). All patients were given (38～40)Gy/(19～20)f by 6/15 MV X-ray during the fist two thirds of the course,and followed by LCAHR and 3DCRT or LCAHR (1.4～1.5) Gy per fraction, twice daily ).The total dose varied up to 65～68Gy.Chemotherapy regimen was FP (5-Fu and DDP). Results Complete response rate was 53.5% and 36.7%,and partial response rate was 43.3% and 36.7% in 3DCRT group and control group after three months treatment. No case with progression of disesse was observed.The CR+PR rate were 90.0% and 80.0%（χ²=1.17,P＞0.05)in 2 groups.The 1,3 and 5 year survival rates were 80.0%、33.3% and 13.3% in 3DCRT group, and 73.3%,20.0% and 6.7%(χ²=0.80、1.36、0.91,P＞0.05) in control group.Conclusion Chemotherapy combined with 3DCRT,with decreased side effects, markedly improved the local control rate and survival rate of postoperative esophageal carcinoma patients with mediastinum lymphonode metastasis.