胸下段食管癌术后放射治疗的范围_West China Medical Journal

Authors：

邓敏 ,  宫友陵

四川大学华西医院胸部肿瘤科（成都 610041）;

Corresponding author：

宫友陵, Email: gongyouling@hotmail.com

Keywords：

胸下段食管癌; 根治术后; 放射治疗; 锁骨上区淋巴结照射

DOI：

10.7507/1002-0179.201511143

Video：

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Abstract Full text Figures/Tables Video References Cited by

食管癌恶性程度高，全球范围内食管癌死亡率居恶性肿瘤的第 6 位。大多数食管癌的治疗首选手术切除，但根治术后复发率仍较高，局部复发是治疗失败的主要原因，术后预防性放射治疗可提高局部控制率。然而，放射治疗靶区的范围仍存在争议，尤其是胸下段食管癌术后患者行放射治疗时是否需包含锁骨上区淋巴结照射。部分学者认为增加双侧锁骨上区淋巴结照射无意义，但有更多的研究显示增加锁骨上区淋巴结照射可以减少锁骨上区复发率，术后放射治疗时需重点考虑。

Citation： 邓敏, 宫友陵. 胸下段食管癌术后放射治疗的范围. 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, 陈国雄, 王迎选. 食管癌术后放射治疗. 中华放射肿瘤学杂志, 1998, 7(1): 46-48.
12.	乔学英, 高献书. 食管癌根治术后放疗. 中华放射肿瘤学杂志, 2006, 15(6): 516-519.
13.	陈俊强, 陈明强, 李云英, 等. 胸段食管癌三野根治术后放疗靶区的临床研究. 中华放射医学与防护杂志, 2006, 26(4): 374-377.
14.	刘俊, 吕长兴, 王家明, 等. 胸段食管癌术后局部复发因素在确定术后放射治疗指征及放疗靶区中的价值. 肿瘤, 2012, 32(4): 286-290.
15.	康静静, 惠周光. 食管癌术后放疗研究现状. 临床外科杂志, 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.	郑明章, 林柏翰, 陈志坚, 等. 食管癌术后放疗靶区的确定. 广东医学, 2004, 25(3): 301-302.
18.	朱琪伟, 蔡晶, 黄灿红, 等. 98 例食管癌患者术后复发和放疗靶区设计. 重庆医学, 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.	蒋华勇, 王雅棣, 许卫东, 等. 胸段食管癌三野根治术后淋巴结转移分析及放疗靶区探讨. 现代肿瘤医学, 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, 祝淑钗, 刘志坤, 等. 胸段食管癌的淋巴结转移规律及其对确定术后放射治疗靶区范围的价值. 中华肿瘤杂志, 2010, 32(5): 391-395.
24.	肖泽芬, 周宗玫, 吕纪马, 等. 胸段食管癌淋巴结转移规律与术后放疗范围的探讨. 中华放射肿瘤学杂志, 2008, 17(6): 427-431.
25.	张明霞, 孔令玲. 食管癌术后放疗靶区的确定. 安徽医药, 2010, 14(10): 1165-1166.
26.	叶尔佳, 王昊飞, 郑小康, 等. 胸段食管癌术后复发模式与放疗靶区的设计. 暨南大学学报: 自然科学与医学版, 2011, 32(4): 411-414.
27.	孙荣刚. 食管癌术后纵隔各分区的淋巴结转移概率研究. 现代肿瘤医学, 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.	梅泽如, 项其昌, 吴维继, 等. 食管癌术后预防性放疗前瞻性研究. 中华放射肿瘤学杂志, 1997(3): 188-189.
31.	李云英, 林祥松, 佘志廉, 等. 食管癌根治术后预防性T型野放射治疗意义的探讨. 中华放射肿瘤学杂志, 1996, 5(1): 53-54.
32.	陈俊强, 朱坤寿, 郑雄伟, 等. 颈部淋巴结转移胸段食管鳞癌术后患者的预后分析. 中华肿瘤杂志, 2014, 36(8): 612-616.
33.	肖泽芬, 杨宗贻, 梁军, 等. 食管癌根治术后预防性放射治疗的临床价值. 中华肿瘤杂志, 2002, 24(6): 608-611.
34.	肖泽芬, 杨宗贻, 王绿化, 等. 食管癌术后淋巴结转移对生存率的影响和放射治疗的意义. 中华肿瘤杂志, 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.	陆进成, 钱普东, 查文武, 等. 食管癌根治术后预防性放射治疗随机研究的 Meta 分析. 循证医学, 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.	张新良, 张道富, 王晓萍, 等. 胸段食管癌术后预防照射三维适形放疗与常规放疗剂量学比较. 临床肿瘤学杂志, 2008, 13(5): 421-423.
43.	刘晓, 章文成, 于舒飞, 等. T2-3N0M0 期食管癌 R0 术后失败模式分析——术后放疗潜在价值与意义. 中华放射肿瘤学杂志, 2015, 24(1): 19-24.
44.	杨劲松, 章文成, 肖泽芬, 等. 术后辅助 3DRT 改善 pT3N0M0 期食管癌患者长期生存. 中华放射肿瘤学杂志, 2015, 24(2): 101-105.
45.	何健, 曾昭冲, 王群, 等. 食管癌术后淋巴结转移术后局部小野放疗疗效. 中国临床医学, 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.	刘美琴, 王崇. 食管癌术后局部和区域复发状况及放疗靶区研究. 实用癌症杂志, 2014(8): 957-959.
48.	钱普东, 陆进成, 梅泽如, 等. 食管癌术后锁骨上野放疗与食管气管沟淋巴结转移关系的探讨. 中华放射肿瘤学杂志, 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, 陈国雄, 王迎选. 食管癌术后放射治疗. 中华放射肿瘤学杂志, 1998, 7(1): 46-48.
12. 乔学英, 高献书. 食管癌根治术后放疗. 中华放射肿瘤学杂志, 2006, 15(6): 516-519.
13. 陈俊强, 陈明强, 李云英, 等. 胸段食管癌三野根治术后放疗靶区的临床研究. 中华放射医学与防护杂志, 2006, 26(4): 374-377.
14. 刘俊, 吕长兴, 王家明, 等. 胸段食管癌术后局部复发因素在确定术后放射治疗指征及放疗靶区中的价值. 肿瘤, 2012, 32(4): 286-290.
15. 康静静, 惠周光. 食管癌术后放疗研究现状. 临床外科杂志, 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. 郑明章, 林柏翰, 陈志坚, 等. 食管癌术后放疗靶区的确定. 广东医学, 2004, 25(3): 301-302.
18. 朱琪伟, 蔡晶, 黄灿红, 等. 98 例食管癌患者术后复发和放疗靶区设计. 重庆医学, 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. 蒋华勇, 王雅棣, 许卫东, 等. 胸段食管癌三野根治术后淋巴结转移分析及放疗靶区探讨. 现代肿瘤医学, 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, 祝淑钗, 刘志坤, 等. 胸段食管癌的淋巴结转移规律及其对确定术后放射治疗靶区范围的价值. 中华肿瘤杂志, 2010, 32(5): 391-395.
24. 肖泽芬, 周宗玫, 吕纪马, 等. 胸段食管癌淋巴结转移规律与术后放疗范围的探讨. 中华放射肿瘤学杂志, 2008, 17(6): 427-431.
25. 张明霞, 孔令玲. 食管癌术后放疗靶区的确定. 安徽医药, 2010, 14(10): 1165-1166.
26. 叶尔佳, 王昊飞, 郑小康, 等. 胸段食管癌术后复发模式与放疗靶区的设计. 暨南大学学报: 自然科学与医学版, 2011, 32(4): 411-414.
27. 孙荣刚. 食管癌术后纵隔各分区的淋巴结转移概率研究. 现代肿瘤医学, 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. 梅泽如, 项其昌, 吴维继, 等. 食管癌术后预防性放疗前瞻性研究. 中华放射肿瘤学杂志, 1997(3): 188-189.
31. 李云英, 林祥松, 佘志廉, 等. 食管癌根治术后预防性T型野放射治疗意义的探讨. 中华放射肿瘤学杂志, 1996, 5(1): 53-54.
32. 陈俊强, 朱坤寿, 郑雄伟, 等. 颈部淋巴结转移胸段食管鳞癌术后患者的预后分析. 中华肿瘤杂志, 2014, 36(8): 612-616.
33. 肖泽芬, 杨宗贻, 梁军, 等. 食管癌根治术后预防性放射治疗的临床价值. 中华肿瘤杂志, 2002, 24(6): 608-611.
34. 肖泽芬, 杨宗贻, 王绿化, 等. 食管癌术后淋巴结转移对生存率的影响和放射治疗的意义. 中华肿瘤杂志, 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. 陆进成, 钱普东, 查文武, 等. 食管癌根治术后预防性放射治疗随机研究的 Meta 分析. 循证医学, 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. 张新良, 张道富, 王晓萍, 等. 胸段食管癌术后预防照射三维适形放疗与常规放疗剂量学比较. 临床肿瘤学杂志, 2008, 13(5): 421-423.
43. 刘晓, 章文成, 于舒飞, 等. T2-3N0M0 期食管癌 R0 术后失败模式分析——术后放疗潜在价值与意义. 中华放射肿瘤学杂志, 2015, 24(1): 19-24.
44. 杨劲松, 章文成, 肖泽芬, 等. 术后辅助 3DRT 改善 pT3N0M0 期食管癌患者长期生存. 中华放射肿瘤学杂志, 2015, 24(2): 101-105.
45. 何健, 曾昭冲, 王群, 等. 食管癌术后淋巴结转移术后局部小野放疗疗效. 中国临床医学, 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. 刘美琴, 王崇. 食管癌术后局部和区域复发状况及放疗靶区研究. 实用癌症杂志, 2014(8): 957-959.
48. 钱普东, 陆进成, 梅泽如, 等. 食管癌术后锁骨上野放疗与食管气管沟淋巴结转移关系的探讨. 中华放射肿瘤学杂志, 2005, 14(5): 401-403.

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