目的 回顾性分析食管癌根治术后预防性放疗或放化疗的临床疗效。方法 163例食管癌根治术后2月内行预防性放射治疗，其中125例术后单纯放射治疗（单放组），38例行术后序贯性放疗和化疗（放化组）。全纵隔放疗剂量45～60Gy，44例行双锁骨上预防性照射，剂量为50Gy。结果 全组1、3、5年生存率和中位生存期分别为84.05%、45.75%、35.89%和32个月。单因素分析显示肿瘤T分期、N分期、TNM病理分期、放疗总剂量和化疗与食管癌术后放疗的预后生存有关，p<0.05；多因素分析仅TNM分期和化疗是独立的预后因素。术后放化疗组1、3、5年生存率分别为84.21%、29.91%和24.93%，而术后单纯放疗组为84.00%、50.6%和39.18%，p<0.05。结论 TNM分期和化疗是影响食管癌术后长期生存的独立预后因素，术后放化疗降低长期生存率的原因有待进一步探讨。

目的 探讨非手术治疗的食管癌临床分期，为放化疗综合治疗方案的选择提供参考标准并准确评估预后。方法 回顾性分析单纯放射治疗的500例中晚期食管癌，根据食管钡餐X片病变长度、CT外侵程度以及病变与周围组织器官的关系，将病变局部分为T1、T2a、T2b、T3a、T3b、T4，结合区域淋巴结转移对应临床分期Ⅰ、Ⅱa、Ⅱb、Ⅲa、Ⅲb、Ⅳ期六分类法和Ⅰ、Ⅱ、Ⅲ、Ⅳ四分类法。结果 500例中晚期食管癌中，T1 23例、T2a 111例、T2b 157例、T3a 84例、T3b82例、T443例，该六组病人1、2、3、4、5年生存率均有显著性差别，X2=63.52，P=0。T2a与T2b、T3a与T3b合并后为四分类法，对应T1 23例、T2268例、T3166例、T443例，该四组病人1、2、3、4、5年生存率均有显著性差别，X2=56.29，P=0。T分期和N分期结合后分类，对应Ⅰ期21例、Ⅱa期96例、Ⅱb期139例、Ⅲa期89例、Ⅲb期87例、Ⅳ期68例，六组病人1、2、3、4、5年生存率有显著性差别，X2=94.29，P=0，组内每两组比较均接近显著性差别。TN结合后对应四分类法Ⅰ期21例、Ⅱ期235例、Ⅲ期176例、Ⅳ期68例，其1、2、3、4、5年生存率有显著性差别，X2=83.48，P=0，每两组依次比较均有显著性差别，P均<0.005。结论 中晚期食管癌临床分期的六分类法和四分类法均能较好地预示食管癌放射治疗后的预后生存，为临床应用方便，建议使用四分类法。

目的 探讨食管癌根治术后不同部位复发放射治疗的疗效和预后影响因素。方法 回顾性分析了110例食管癌根治术后不同部位复发的病人，其中单纯颈部淋巴结转移17例、纵隔淋巴结转移72例、腹部淋巴结转移5例、吻合口复发16例。放射治疗采用60Co或6MV X线，中位照射剂量为62Gy。结果 全组术后放疗后1、2、3、4年总生存率和中位生存期分别为55.41%、30.35%、21.76%、14.47%和14个月。单因素分析显示肿瘤复发部位、放疗后症状缓解情况、放疗后近期疗效、术后肿瘤T分期及放疗总剂量与预后有关，p值均<0.05；多因素分析仅放疗后症状缓解情况和术后TNM病理分期为独立预后因素。 结论 食管癌术后复发放射治疗可以延长部分病人的生存时间，手术时TNM病理分期早以及放疗后症状缓解者预后较好。

To evaluate the effect and complications of esophageal carcinoma treated by external beam and intracavitary radiation with carboplatin chemotherapy. From September 1993 to May 1994, 129 advanced esophageal carcinoma patients were treated by combined radiotherapy and chemotherapy with prospective randomized study. All confirmed by pathological as squamous cell carcinoma. The follow-up rate was 98.5%. Group A: 33 patients received conventional radiotherapy. Group B: 32 patients were given external beam and intracavitary irradiation. Group C:31 patients received the external and intracavitary irradiation as same as Group B, and plus single drug carboplatin as chemotherapy. Group D: 33 patients were given external beam radiotherapy as same as group A and the chemotherapy regimen identified to group C. The 3-,4-year survival rates were significant difference between groups A and D, p=0.027 and p=0.071 respectively; The 3-year disease-free survival rates of group D 36.9% (12/33) was higher than those of group A 15.2% (5/33), p=0.048; The A, B, C and D group's median survival time were 12 months, 18 months, 13 months and 16 months, respectively. Non-carcinomatous esophageal stenosis, ulcer and fistula were the common and severe complications. There were no significant difference in any groups about the ulcer and fistula mortality, but esophageal stenosis in groups B, C were 43.8%(14/32) and 38.5%(12/31) higher than groups A, D 9.1%(3/33) and 12.1%(4/33), P<0.05. 108 patients had died. The local failure resulted in dead 63 cases (58.3%). In group A, die of local relapse 55.2%(16/29) were markedly higher than group B 22.2%(6/27), p=0.012 and group C21.4%(6/28), p=0.009. The external beam with intracavitary radiation show the local relapse down but could not improved the long-term survival, and the severe complications were markedly higher influencing the quality of life and the survival; External beam radiation plus carboplatin chemotherapy seemed to improve the survival rates and need intensive study.

目的 研究食管内置金属支架对放疗剂量的影响，以便在临床应用中进行适当修正。方法 采用热释光元件测量。测量探测器为国产Fj-427A热释光剂量仪，热释光元件为LiF（Mg，P，Cu）片状型剂量元件，分别测量两种（进口及国产）食管内置网状金属支架及未放支架的石蜡体模，测量支架周围（即食管粘膜处）的剂量并与无支架时食管中心点的剂量进行比较。结果 国产支架单野垂直照射时沿射束方向，支架前点和后点对60钴γ线、4MV-X线、6MV-X线剂量增加分别是16.2%和7.8%、15.4%和6.8%、12.8%和5.8%，进口支架单野垂直照射剂量增加分别是13.0%和7.0%、11.7%和6.0%、8.5%和3.2%；前后两野对穿照射剂量增加11.7～24.0%，当三野交角照射支架周围（食管粘膜）均增加3.2～16.2%。结论 置放食管网状金属支架后进行常规放疗时，（1）单次剂量最好不超过1.7Gy，前后对穿野照射时不超过1.5Gy。（2）建议使用直径小于1.5厘米支架。（3）食管癌带支架放疗，最好选用三野交叉照射。

AIM: The aim of the present study is to use immunohistochemical methods to investigate the clinical implications of tumor markers in esophageal squamous cell carcinoma and evaluate their impact on prognosis. METHODS: From November 1990 to December 1996, 47 patients were treated with preoperative radiation followed by radical esophagectomy. All patients were confirmed pathologically as suffering from squamous cell carcinoma. Immunohistochemical stain was done for PCNA, cyclinD1 protein expression and DNA content analyzed by image cytometry. Kaplan-Meier method for single prognostic factor and Log-rank test was used to test the significant difference. Cox stepwise regression model and prognosis index model were used for survival analysis with multiple prognostic factors. RESULTS: Radio-pathological change, T stage and N stage, as the traditional prognostic factors had statistical difference in 3-, 5- and 10-year survival rates. While, tumor cell proliferating marked PCNA, cyclinD1 and DNA content served as independent prognostic factors of esophageal carcinoma. There was definitely identity between the single factor and multiple factor analyses. PI was more accurate to evaluate the prognosis of esophageal carcinoma. CONCLUSION: It is possible that tumor cell proliferating marked PCNA, cyclinD1 and DNA content would become the endpoints for evaluating the prognosis of esophageal carcinoma.

目的 探讨放射治疗前后PCNA，cyclinD1蛋白表达和DNA含量分型3项指标同时检测对食管癌预后的指导作用。方法 在本院接受术前放射治疗及根治性食管癌切除术的47例食管癌患者中男28例，女19例；单因素生存分析采用Kaplan-Meier方法并用Log-rank检验，多因素分析用Cox逐步回归模型，预后指数模型对整组病例进行多因素综合分析。结果 传统预后因素放射治疗后病理改变、T分期、N分期和肿瘤细胞基因蛋白PCNA，cyclinD1，DNA含量均可作为食管癌术前放射治疗预后生存的独立预后因素，多因素分析显示出同样结果，预后指数模型更敏感地反映出不同亚组的生存情况。结论 除传统预后因素外，肿瘤细胞标志物PCNA，cyclinD1，DNA有可能成为评估食管癌预后的参考指标，预后指数与各种单因素比较能更准确地提示预后生存。

目的：探讨内窥镜活检标本PCNA、cyclinD1蛋白表达和DNA含量分型同时检测对食管癌放疗预后的指导作用。方法：1979年11月至1996年12月，104例食管癌患者在我院接受术前放疗及根治性食管癌切除术，其中男64例，女40例，平均年龄51岁（31～72岁）。均用前后两野垂直照射，肿瘤剂量30～40Gy/15～20次/3～4周。结果：PCNA蛋白高表达率55.8%，cyclinD1蛋白表达阳性率为62.5%，DNA含量Ⅰ、Ⅱ型者占21.3%，Ⅲ、Ⅳ型者占78.3%。PCNA蛋白高表达者较低表达者预后好P=0.02，并与肿瘤大小、淋巴结转移状态和放疗后病理改变均有明显相关性；cyclinD1蛋白表达和 DNA含量对预后均无显著性影响且与临床病理参数无明显相关性；但cyclinD1蛋白和DNA含量之间有显著性相关p=0.03，二者结合对食管癌预后有显著性影响p=0.01；Cox模型分析显示，仅淋巴结转移状态、术前放疗剂量和放疗前PCNA蛋白表达对预后有比较明显的影响。结论：活检标本PCNA蛋白表达有可能预示食管癌预后，cyclinD1蛋白和DNA含量结合有可能成为新的评价指标。

目的 分析中晚期食管癌单纯放射治疗的预后因素，为个体化治疗方案制定和准确评估预后提供参考标准。方法 1997年1月至1998年12月在我科接受单纯放射治疗的胸段食管癌病人500例，男318例，女182例，中位年龄56.5岁；胸上段癌195例，胸中段癌277例，胸下段癌28例；X片病变长度≤3.0cm者36例，3.1～7.0cm者318例，7.1～10.0cm者132例，>10.0cm者14例；胸部CT扫描显示病变长度≤3.0cm者14例，3.1～7.0cm者130例，7.1～10.0cm者298例，>10.0cm者58例。病变最大层面上测量肿瘤最大直径，≤2.0cm者87例，2.1～3.0cm者153例，>3.1cm者260例。应用6MV X-ray直线加速器给予一前、两后斜野等中心或源皮距照射，常规分割或后程加速超分割，总剂量60～66Gy/30～39次/5～5.3周。结果 全组1、3、5年生存率分别为71.06%、32.62%、20.81%。单因素分析显示传统预后因素性别、声哑、病变部位、病变长度、软组织阴影、溃疡和食管腔扭曲成角均明显影响预后；CT扫描相关因素如病变长度、最大外侵深度、最大直径、气管支气管受侵、降主动脉受侵、椎前三角消失和淋巴结转移也显著影响长期生存；治疗相关因素如前垂直野宽、野长、后斜野宽、野长、总剂量、总疗程时间、即时疗效和近期疗效对生存也有显著影响，均有统计学意义。Cox多因素分析显示淋巴结转移、CT显示的病变最大直径、声哑、CT显示病变长度、病变部位、病变最大外侵程度、后斜野宽度、总疗程时间、即时疗效和近期疗效均为独立性预后因素。综合多种因素的预后指数PI值越低，预后越好。结论 中晚期食管癌单纯放射治疗后，除传统预后因素外，胸部CT扫描能提供更准确的评估预后的指标，预后指数模型能够更敏感地预测疗后生存。