胸下段食管癌術后放射治療的范圍_West China Medical Journal

Authors：

鄧敏 ,  宮友陵

四川大學華西醫院胸部腫瘤科（成都 610041）;

Corresponding?author：

宮友陵, Email: gongyouling@hotmail.com

Keywords：

胸下段食管癌; 根治術后; 放射治療; 鎖骨上區淋巴結照射

DOI：

10.7507/1002-0179.201511143

Video：

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Abstract Full text Figures/Tables Video References Cited by

食管癌惡性程度高，全球范圍內食管癌死亡率居惡性腫瘤的第 6 位。大多數食管癌的治療首選手術切除，但根治術后復發率仍較高，局部復發是治療失敗的主要原因，術后預防性放射治療可提高局部控制率。然而，放射治療靶區的范圍仍存在爭議，尤其是胸下段食管癌術后患者行放射治療時是否需包含鎖骨上區淋巴結照射。部分學者認為增加雙側鎖骨上區淋巴結照射無意義，但有更多的研究顯示增加鎖骨上區淋巴結照射可以減少鎖骨上區復發率，術后放射治療時需重點考慮。

Citation： 鄧敏, 宮友陵. 胸下段食管癌術后放射治療的范圍. West China Medical Journal, 2017, 32(6): 954-958. doi: 10.7507/1002-0179.201511143 Copy

1.	Torre LA, Bray F, Siegel RL, et al. Global cancer statistics, 2012. CA Cancer J Clin, 2015, 65(2): 87-108.
2.	Pennathur A, Gibson MK, Jobe BA, et al. Oesophageal carcinoma. Lancet, 2013, 381(9864): 400-412.
3.	Chen W, Zheng R, Zhang S, et al. Report of cancer incidence and mortality in China, 2010. Ann Transl Med, 2014, 2(7): 61.
4.	Wheeler JB, Reed CE. Epidemiology of esophageal cancer. Surg Clin North Am, 2012, 92(5): 1077-1087.
5.	Ren Y, Su C, Zhou Y, et al. Effect of bilateral supraclavicular postoperative radiotherapy in middle and lower thoracic esophageal carcinoma. World J Gastroenterol, 2014, 20(47): 17970-17975.
6.	Almhanna K, Shridhar R, Meredith KL. Neoadjuvant or adjuvant therapy for resectable esophageal cancer: is there a standard of care?. Cancer Control, 2013, 20(2): 89-96.
7.	Nakagawa S, Kanda T, Kosugi S, et al. Recurrence pattern of squamous cell carcinoma of the thoracic esophagus after extended radical esophagectomy with three-field lymphadenectomy. J Am Coll Surg, 2004, 198(2): 205-211.
8.	Mariette C, Balon JM, Piessen G, et al. Pattern of recurrence following complete resection of esophageal carcinoma and factors predictive of recurrent disease. Cancer, 2003, 97(7): 1616-1623.
9.	Cai WJ, Xin PL. Pattern of relapse in surgical treated patients with thoracic esophageal squamous cell carcinoma and its possible impact on target delineation for postoperative radiotherapy. Radiother Oncol, 2010, 96(1): 104-107.
10.	Li CL, Zhang FL, Wang YD, et al. Characteristics of recurrence after radical esophagectomy with two-field lymph node dissection for thoracic esophageal cancer. Oncol Lett, 2013, 5(1): 355-359.
11.	朱海文, 陳國雄, 王迎選. 食管癌術后放射治療. 中華放射腫瘤學雜志, 1998, 7(1): 46-48.
12.	喬學英, 高獻書. 食管癌根治術后放療. 中華放射腫瘤學雜志, 2006, 15(6): 516-519.
13.	陳俊強, 陳明強, 李云英, 等. 胸段食管癌三野根治術后放療靶區的臨床研究. 中華放射醫學與防護雜志, 2006, 26(4): 374-377.
14.	劉俊, 呂長興, 王家明, 等. 胸段食管癌術后局部復發因素在確定術后放射治療指征及放療靶區中的價值. 腫瘤, 2012, 32(4): 286-290.
15.	康靜靜, 惠周光. 食管癌術后放療研究現狀. 臨床外科雜志, 2016, 24(7): 562-565.
16.	Zhu Y, Li M, Kong L, et al. Postoperative radiation in esophageal squamous cell carcinoma and target volume delineation. Onco Targets Ther, 2016, 9(9): 4187-4196.
17.	鄭明章, 林柏翰, 陳志堅, 等. 食管癌術后放療靶區的確定. 廣東醫學, 2004, 25(3): 301-302.
18.	朱琪偉, 蔡晶, 黃燦紅, 等. 98 例食管癌患者術后復發和放療靶區設計. 重慶醫學, 2013, 42(14): 1580-1582.
19.	Huang W, Li BS, Gong HY, et al. Pattern of lymph node metastases and its implication in radiotherapeutic clinical target volume in patients with thoracic esophageal squamous cell carcinoma: a report of 1077 cases. Radiother Oncol, 2010, 95(2): 229-233.
20.	Lu JC, Tao H, Zhang YQ, et al. Extent of prophylactic postoperative radiotherapy after radical surgery of thoracic esophageal squamous cell carcinoma. Dis Esophagus, 2008, 21(6): 502-507.
21.	蔣華勇, 王雅棣, 許衛東, 等. 胸段食管癌三野根治術后淋巴結轉移分析及放療靶區探討. 現代腫瘤醫學, 2014, 22(7): 1594-1596.
22.	Ding X, Zhang J, Li B, et al. A meta-analysis of lymph node metastasis rate for patients with thoracic oesophageal cancer and its implication in delineation of clinical target volume for radiation therapy. Br J Radiol, 2012, 85(119): e1110-e1119.
23.	李幼梅, 祝淑釵, 劉志坤, 等. 胸段食管癌的淋巴結轉移規律及其對確定術后放射治療靶區范圍的價值. 中華腫瘤雜志, 2010, 32(5): 391-395.
24.	肖澤芬, 周宗玫, 呂紀馬, 等. 胸段食管癌淋巴結轉移規律與術后放療范圍的探討. 中華放射腫瘤學雜志, 2008, 17(6): 427-431.
25.	張明霞, 孔令玲. 食管癌術后放療靶區的確定. 安徽醫藥, 2010, 14(10): 1165-1166.
26.	葉爾佳, 王昊飛, 鄭小康, 等. 胸段食管癌術后復發模式與放療靶區的設計. 暨南大學學報: 自然科學與醫學版, 2011, 32(4): 411-414.
27.	孫榮剛. 食管癌術后縱隔各分區的淋巴結轉移概率研究. 現代腫瘤醫學, 2013, 21(10): 2257-2260.
28.	Ténière P, Hay JM, Fingerhut A, et al. Postoperative radiation therapy does not increase survival after curative resection for squamous cell carcinoma of the middle and lower esophagus as shown by a multicenter controlled trial. French University Association for Surgical Research. Surg Gynecol Obstet, 1991, 173(2): 123-130.
29.	Zieren HU, Müller JM, Jacobi CA, et al. Adjuvant postoperative radiation therapy after curative resection of squamous cell carcinoma of the thoracic esophagus: a prospective randomized study. World J Surg, 1995, 19(3): 444-449.
30.	梅澤如, 項其昌, 吳維繼, 等. 食管癌術后預防性放療前瞻性研究. 中華放射腫瘤學雜志, 1997(3): 188-189.
31.	李云英, 林祥松, 佘志廉, 等. 食管癌根治術后預防性T型野放射治療意義的探討. 中華放射腫瘤學雜志, 1996, 5(1): 53-54.
32.	陳俊強, 朱坤壽, 鄭雄偉, 等. 頸部淋巴結轉移胸段食管鱗癌術后患者的預后分析. 中華腫瘤雜志, 2014, 36(8): 612-616.
33.	肖澤芬, 楊宗貽, 梁軍, 等. 食管癌根治術后預防性放射治療的臨床價值. 中華腫瘤雜志, 2002, 24(6): 608-611.
34.	肖澤芬, 楊宗貽, 王綠化, 等. 食管癌術后淋巴結轉移對生存率的影響和放射治療的意義. 中華腫瘤雜志, 2004, 26(2): 112-115.
35.	Xu Y, Liu J, Du X, et al. Prognostic impact of postoperative radiation in patients undergoing radical esophagectomy for pathologic lymph node positive esophageal cancer. Radiat Oncol, 2013, 8: 116.
36.	Schreiber D, Rineer J, Vongtama D, et al. Impact of postoperative radiation after esophagectomy for esophageal cancer. J Thorac Oncol, 2010, 5(2): 244-250.
37.	Xiao ZF, Yang ZY, Miao YJ, et al. Influence of number of metastatic lymph nodes on survival of curative resected thoracic esophageal cancer patients and value of radiotherapy: report of 549 cases. Int J Radiat Oncol Biol Phys, 2005, 62(1): 82-90.
38.	Chen J, Pan J, Zheng X, et al. Number and location of positive nodes, postoperative radiotherapy, and survival after esophagectomy with three-field lymph node dissection for thoracic esophageal squamous cell carcinoma. Int J Radiat Oncol Biol Phys, 2012, 82(1): 475-482.
39.	陸進成, 錢普東, 查文武, 等. 食管癌根治術后預防性放射治療隨機研究的 Meta 分析. 循證醫學, 2005, 5(3): 166-168, 171.
40.	Zhang W, Liu X, Xiao Z, et al. Postoperative intensity-modulated radiotherapy improved survival in lymph node-positive or stage Ⅲ thoracic esophageal squamous cell carcinoma. Oncol Res Treat, 2015, 38(3): 97-102.
41.	Chen J, Zhu J, Pan J, et al. Postoperative radiotherapy improved survival of poor prognostic squamous cell carcinoma esophagus. Ann Thorac Surg, 2010, 90(2): 435-442.
42.	張新良, 張道富, 王曉萍, 等. 胸段食管癌術后預防照射三維適形放療與常規放療劑量學比較. 臨床腫瘤學雜志, 2008, 13(5): 421-423.
43.	劉曉, 章文成, 于舒飛, 等. T2-3N0M0 期食管癌 R0 術后失敗模式分析——術后放療潛在價值與意義. 中華放射腫瘤學雜志, 2015, 24(1): 19-24.
44.	楊勁松, 章文成, 肖澤芬, 等. 術后輔助 3DRT 改善 pT3N0M0 期食管癌患者長期生存. 中華放射腫瘤學雜志, 2015, 24(2): 101-105.
45.	何健, 曾昭沖, 王群, 等. 食管癌術后淋巴結轉移術后局部小野放療療效. 中國臨床醫學, 2006, 13(6): 921-923.
46.	Liu Q, Cai XW, Wu B, et al. Patterns of failure after radical surgery among patients with thoracic esophageal squamous cell carcinoma: implications for the clinical target volume design of postoperative radiotherapy. PLoS One, 2014, 9(5): e97225.
47.	劉美琴, 王崇. 食管癌術后局部和區域復發狀況及放療靶區研究. 實用癌癥雜志, 2014(8): 957-959.
48.	錢普東, 陸進成, 梅澤如, 等. 食管癌術后鎖骨上野放療與食管氣管溝淋巴結轉移關系的探討. 中華放射腫瘤學雜志, 2005, 14(5): 401-403.

1. Torre LA, Bray F, Siegel RL, et al. Global cancer statistics, 2012. CA Cancer J Clin, 2015, 65(2): 87-108.
2. Pennathur A, Gibson MK, Jobe BA, et al. Oesophageal carcinoma. Lancet, 2013, 381(9864): 400-412.
3. Chen W, Zheng R, Zhang S, et al. Report of cancer incidence and mortality in China, 2010. Ann Transl Med, 2014, 2(7): 61.
4. Wheeler JB, Reed CE. Epidemiology of esophageal cancer. Surg Clin North Am, 2012, 92(5): 1077-1087.
5. Ren Y, Su C, Zhou Y, et al. Effect of bilateral supraclavicular postoperative radiotherapy in middle and lower thoracic esophageal carcinoma. World J Gastroenterol, 2014, 20(47): 17970-17975.
6. Almhanna K, Shridhar R, Meredith KL. Neoadjuvant or adjuvant therapy for resectable esophageal cancer: is there a standard of care?. Cancer Control, 2013, 20(2): 89-96.
7. Nakagawa S, Kanda T, Kosugi S, et al. Recurrence pattern of squamous cell carcinoma of the thoracic esophagus after extended radical esophagectomy with three-field lymphadenectomy. J Am Coll Surg, 2004, 198(2): 205-211.
8. Mariette C, Balon JM, Piessen G, et al. Pattern of recurrence following complete resection of esophageal carcinoma and factors predictive of recurrent disease. Cancer, 2003, 97(7): 1616-1623.
9. Cai WJ, Xin PL. Pattern of relapse in surgical treated patients with thoracic esophageal squamous cell carcinoma and its possible impact on target delineation for postoperative radiotherapy. Radiother Oncol, 2010, 96(1): 104-107.
10. Li CL, Zhang FL, Wang YD, et al. Characteristics of recurrence after radical esophagectomy with two-field lymph node dissection for thoracic esophageal cancer. Oncol Lett, 2013, 5(1): 355-359.
11. 朱海文, 陳國雄, 王迎選. 食管癌術后放射治療. 中華放射腫瘤學雜志, 1998, 7(1): 46-48.
12. 喬學英, 高獻書. 食管癌根治術后放療. 中華放射腫瘤學雜志, 2006, 15(6): 516-519.
13. 陳俊強, 陳明強, 李云英, 等. 胸段食管癌三野根治術后放療靶區的臨床研究. 中華放射醫學與防護雜志, 2006, 26(4): 374-377.
14. 劉俊, 呂長興, 王家明, 等. 胸段食管癌術后局部復發因素在確定術后放射治療指征及放療靶區中的價值. 腫瘤, 2012, 32(4): 286-290.
15. 康靜靜, 惠周光. 食管癌術后放療研究現狀. 臨床外科雜志, 2016, 24(7): 562-565.
16. Zhu Y, Li M, Kong L, et al. Postoperative radiation in esophageal squamous cell carcinoma and target volume delineation. Onco Targets Ther, 2016, 9(9): 4187-4196.
17. 鄭明章, 林柏翰, 陳志堅, 等. 食管癌術后放療靶區的確定. 廣東醫學, 2004, 25(3): 301-302.
18. 朱琪偉, 蔡晶, 黃燦紅, 等. 98 例食管癌患者術后復發和放療靶區設計. 重慶醫學, 2013, 42(14): 1580-1582.
19. Huang W, Li BS, Gong HY, et al. Pattern of lymph node metastases and its implication in radiotherapeutic clinical target volume in patients with thoracic esophageal squamous cell carcinoma: a report of 1077 cases. Radiother Oncol, 2010, 95(2): 229-233.
20. Lu JC, Tao H, Zhang YQ, et al. Extent of prophylactic postoperative radiotherapy after radical surgery of thoracic esophageal squamous cell carcinoma. Dis Esophagus, 2008, 21(6): 502-507.
21. 蔣華勇, 王雅棣, 許衛東, 等. 胸段食管癌三野根治術后淋巴結轉移分析及放療靶區探討. 現代腫瘤醫學, 2014, 22(7): 1594-1596.
22. Ding X, Zhang J, Li B, et al. A meta-analysis of lymph node metastasis rate for patients with thoracic oesophageal cancer and its implication in delineation of clinical target volume for radiation therapy. Br J Radiol, 2012, 85(119): e1110-e1119.
23. 李幼梅, 祝淑釵, 劉志坤, 等. 胸段食管癌的淋巴結轉移規律及其對確定術后放射治療靶區范圍的價值. 中華腫瘤雜志, 2010, 32(5): 391-395.
24. 肖澤芬, 周宗玫, 呂紀馬, 等. 胸段食管癌淋巴結轉移規律與術后放療范圍的探討. 中華放射腫瘤學雜志, 2008, 17(6): 427-431.
25. 張明霞, 孔令玲. 食管癌術后放療靶區的確定. 安徽醫藥, 2010, 14(10): 1165-1166.
26. 葉爾佳, 王昊飛, 鄭小康, 等. 胸段食管癌術后復發模式與放療靶區的設計. 暨南大學學報: 自然科學與醫學版, 2011, 32(4): 411-414.
27. 孫榮剛. 食管癌術后縱隔各分區的淋巴結轉移概率研究. 現代腫瘤醫學, 2013, 21(10): 2257-2260.
28. Ténière P, Hay JM, Fingerhut A, et al. Postoperative radiation therapy does not increase survival after curative resection for squamous cell carcinoma of the middle and lower esophagus as shown by a multicenter controlled trial. French University Association for Surgical Research. Surg Gynecol Obstet, 1991, 173(2): 123-130.
29. Zieren HU, Müller JM, Jacobi CA, et al. Adjuvant postoperative radiation therapy after curative resection of squamous cell carcinoma of the thoracic esophagus: a prospective randomized study. World J Surg, 1995, 19(3): 444-449.
30. 梅澤如, 項其昌, 吳維繼, 等. 食管癌術后預防性放療前瞻性研究. 中華放射腫瘤學雜志, 1997(3): 188-189.
31. 李云英, 林祥松, 佘志廉, 等. 食管癌根治術后預防性T型野放射治療意義的探討. 中華放射腫瘤學雜志, 1996, 5(1): 53-54.
32. 陳俊強, 朱坤壽, 鄭雄偉, 等. 頸部淋巴結轉移胸段食管鱗癌術后患者的預后分析. 中華腫瘤雜志, 2014, 36(8): 612-616.
33. 肖澤芬, 楊宗貽, 梁軍, 等. 食管癌根治術后預防性放射治療的臨床價值. 中華腫瘤雜志, 2002, 24(6): 608-611.
34. 肖澤芬, 楊宗貽, 王綠化, 等. 食管癌術后淋巴結轉移對生存率的影響和放射治療的意義. 中華腫瘤雜志, 2004, 26(2): 112-115.
35. Xu Y, Liu J, Du X, et al. Prognostic impact of postoperative radiation in patients undergoing radical esophagectomy for pathologic lymph node positive esophageal cancer. Radiat Oncol, 2013, 8: 116.
36. Schreiber D, Rineer J, Vongtama D, et al. Impact of postoperative radiation after esophagectomy for esophageal cancer. J Thorac Oncol, 2010, 5(2): 244-250.
37. Xiao ZF, Yang ZY, Miao YJ, et al. Influence of number of metastatic lymph nodes on survival of curative resected thoracic esophageal cancer patients and value of radiotherapy: report of 549 cases. Int J Radiat Oncol Biol Phys, 2005, 62(1): 82-90.
38. Chen J, Pan J, Zheng X, et al. Number and location of positive nodes, postoperative radiotherapy, and survival after esophagectomy with three-field lymph node dissection for thoracic esophageal squamous cell carcinoma. Int J Radiat Oncol Biol Phys, 2012, 82(1): 475-482.
39. 陸進成, 錢普東, 查文武, 等. 食管癌根治術后預防性放射治療隨機研究的 Meta 分析. 循證醫學, 2005, 5(3): 166-168, 171.
40. Zhang W, Liu X, Xiao Z, et al. Postoperative intensity-modulated radiotherapy improved survival in lymph node-positive or stage Ⅲ thoracic esophageal squamous cell carcinoma. Oncol Res Treat, 2015, 38(3): 97-102.
41. Chen J, Zhu J, Pan J, et al. Postoperative radiotherapy improved survival of poor prognostic squamous cell carcinoma esophagus. Ann Thorac Surg, 2010, 90(2): 435-442.
42. 張新良, 張道富, 王曉萍, 等. 胸段食管癌術后預防照射三維適形放療與常規放療劑量學比較. 臨床腫瘤學雜志, 2008, 13(5): 421-423.
43. 劉曉, 章文成, 于舒飛, 等. T2-3N0M0 期食管癌 R0 術后失敗模式分析——術后放療潛在價值與意義. 中華放射腫瘤學雜志, 2015, 24(1): 19-24.
44. 楊勁松, 章文成, 肖澤芬, 等. 術后輔助 3DRT 改善 pT3N0M0 期食管癌患者長期生存. 中華放射腫瘤學雜志, 2015, 24(2): 101-105.
45. 何健, 曾昭沖, 王群, 等. 食管癌術后淋巴結轉移術后局部小野放療療效. 中國臨床醫學, 2006, 13(6): 921-923.
46. Liu Q, Cai XW, Wu B, et al. Patterns of failure after radical surgery among patients with thoracic esophageal squamous cell carcinoma: implications for the clinical target volume design of postoperative radiotherapy. PLoS One, 2014, 9(5): e97225.
47. 劉美琴, 王崇. 食管癌術后局部和區域復發狀況及放療靶區研究. 實用癌癥雜志, 2014(8): 957-959.
48. 錢普東, 陸進成, 梅澤如, 等. 食管癌術后鎖骨上野放療與食管氣管溝淋巴結轉移關系的探討. 中華放射腫瘤學雜志, 2005, 14(5): 401-403.

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