食管癌新辅助放化疗中放疗累及野照射的初步研究

董晓欢; 刘俊; 李洪选; 程妍; 李玥; 余雯; 蔡旭伟; 傅小龙

doi:10.19401/j.cnki.1007-3639.2023.03.010

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食管癌新辅助放化疗中放疗累及野照射的初步研究

论著 | 更新时间：2025-12-31

- 食管癌新辅助放化疗中放疗累及野照射的初步研究
- Preliminary study on involving field irradiation radiotherapy in neoadjuvant chemoradiotherapy for esophageal cancer
- 中国癌症杂志 2023年33卷第3期页码：267-273
- 作者机构：
  
  1. 蚌埠医学院研究生院，安徽蚌埠 233000
  2. 上海交通大学医学院附属胸科医院放疗科，上海 200030
- 作者简介：
  
  [ "董晓欢（ORCID: 0000-0001-5028-1857），硕士在读。" ]
  傅小龙（ORCID: 0000-0001-8127-3884），博士，主任医师、教授，上海交通大学医学院附属胸科医院放疗科主任。
- 基金信息：
- DOI：10.19401/j.cnki.1007-3639.2023.03.010
  中图分类号： R735.1
- 收稿：2022-04-25，
  
  修回：2022-08-12，
  
  纸质出版：2023-03-30
- 稿件说明：
移动端阅览
董晓欢, 刘俊, 李洪选, 等. 食管癌新辅助放化疗中放疗累及野照射的初步研究[J]. 中国癌症杂志, 2023,33(3):267-273.

Xiaohuan DONG, Jun LIU, Hongxuan LI, et al. Preliminary study on involving field irradiation radiotherapy in neoadjuvant chemoradiotherapy for esophageal cancer[J]. China Oncology, 2023, 33(3): 267-273.
董晓欢, 刘俊, 李洪选, 等. 食管癌新辅助放化疗中放疗累及野照射的初步研究[J]. 中国癌症杂志, 2023,33(3):267-273. DOI： 10.19401/j.cnki.1007-3639.2023.03.010.

Xiaohuan DONG, Jun LIU, Hongxuan LI, et al. Preliminary study on involving field irradiation radiotherapy in neoadjuvant chemoradiotherapy for esophageal cancer[J]. China Oncology, 2023, 33(3): 267-273. DOI： 10.19401/j.cnki.1007-3639.2023.03.010.

摘要

背景与目的：

局部晚期食管癌患者的标准治疗方案是新辅助放化疗（neoadjuvant chemoradiotherapy，NCRT）联合根治性切除术，但临床上实施这一综合性治疗策略的技术环节存在一定差异性，特别是NCRT中放疗靶区范围的定义一直存在争议。本研究旨在分析局部晚期食管癌NCRT采用累及野照射（involving field irradiation，IFI）的可行性。

方法：

回顾性分析2016年7月—2017年5月在上海交通大学医学院附属胸科医院接受NCRT联合手术的局部晚期食管鳞癌患者，所有患者的放疗靶区均为我们推荐的IFI，再分别按照选择性淋巴引流区预防照射（elective node irradiation，ENI）和原发灶亚临床病灶照射（subclinical lesion irradiation，SLI）两种传统靶区勾画方式对入组患者重新制订放疗计划。比较3组计划的剂量学参数以及双肺、心脏、脊髓等危及器官（organ at risk，OAR）受照剂量差异，并分析IFI失败模式与靶区的关系。

结果：

共入组26例患者。IFI的靶区平均体积为（277±77）cm

，明显低于ENI和SLI（

0.05）。剂量学分析发现，IFI能显著降低双肺受到5、20 Gy以上剂量照射的相对体积分数（

、

）、双肺平均受照剂量（

mean

）、心脏

、心脏

mean

和脊髓最大受照剂量（

max

）（

0.05），双肺

、双肺

mean

、心脏

mean

和脊髓

max

较ENI分别下降27.1%、22.5%、27.4%和6.4%，较SLI分别下降24.1%、22.0%、24.8%和5.7%。经过28~69个月的随访，13例患者发生复发转移，其中7例患者为单纯远处转移，4例患者为照射野内复发，1例患者为照射野外局部复发，3年总生存（overall survival，OS）率和无病生存（disease-free survival，DFS）率分别为50.0%和42.3%。

结论：

本中心建议的IFI在保证临床疗效的同时显著降低

了肺、心脏和脊髓等器官的辐射受量，具有一定的可行性。

Abstract

Background and purpose:

The standard treatment for patients with locally advanced esophageal cancer is neoadjuvant chemoradiotherapy (NCRT) plus radical resection. However

the technical aspects for implementing this comprehensive treatment strategy differ

especially in the controversial definition of the radiotherapy target area in NCRT. This study aimed to analyze the feasibility of involving field irradiation (IFI) in NCRT for locally advanced esophageal cancer.

Methods:

Retrospective analysis of locally advanced esophageal squamous cell carcinoma patients receiving NCRT in Shanghai Chest Hospital

Shanghai Jiao Tong University School of Medicine from July 2016 to May 2017 showed that the radiotherapy target of all patients was our recommended IFI. The radiotherapy plan was redesigned for the enrolled patients according to the two traditional target delineation of elective node irradiation (ENI) and primary subclinical lesion irradiation (SLI). The dosimetric parameters of the three groups and the dose differences of organ at risk (OAR)

such as lungs

heart and spinal cord

were compared

and the relationship between IFI Recurrence pattern and radiation target volumes was analyzed.

Results:

A total of 26 patients were enrolled. The average target volume of IFI was (277±77) cm

which was significantly lower compared with ENI and SLI (

0.05). IFI could significantly reduce relative volume fraction of lungs irradiated more than 5 and 20 Gy (

and

)

lungs average dose (

mean

)

heart

mean

and spinal cord maximum dose (

max

) (

0.05)

compared with ENI. Lungs

lungs

mean

heart

mean

and spinal cord

max

decreased by 27.1%

22.5%

27.4% and 6.4% compared with ENI

and 24.1%

22.0%

24.8% and 5.7% compared with SLI

respectively. After 28 to 69 months of follow-up

13 patients had recurrence and metastasis

of whom 7 patients had distant metastasis

4 patients had recurrence in the irradiation field

and 1 patient had local recurrence in the irradiation field. The 3-year overall survival (OS) rate and disease-free survival (DFS) rate were 50.0% and 42.3%

respectively.

Conclusion:

IFI recommended by our institution is feasible to ensure clinical efficacy while significantly reducing the radiation dose of lungs

heart and spinal cord.

关键词

Keywords

references

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