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。