中文摘要：

目的 比较根治性单纯放疗的老年食管鳞癌患者行淋巴结累及野照射（IFI）和预防性照射（ENI）的治疗效果,探讨老年患者单纯放疗行淋巴结累及野照射的可行性.方法 收集分析年龄＞70岁,并经病理证实食管鳞癌且行单纯根治性调强放射治疗的老年患者共79例.其中48例进行IFI放疗,31例进行ENI放疗.中位随访时间为24个月,比较两组的疾病无进展生存率、总生存率、治疗失败模式及肺照射剂量及放射性肺炎发生率.结果 1、2、3年疾病无进展生存率,IFI组为60.4％、34.9％、29.7％,ENI组为64.5％、54.0％、35.0％,两者疾病无进展生存率比较差异无统计学意义（P＞0.05）;1、2、3年总生存率IFI组为72.9％、43.4％、31.5％,ENI组为73.0％、53.0％、38.3％,中位生存期两组分别为25和28个月,ENI组有生存提高趋势,但两者差异无统计学意义（P＞0.05）.两组的失败模式类似,远处转移、局部复发、非受累野淋巴结复发率IFI组及ENI组分别为22.9％、27.0％、4.2％和25.8％、0％、19.4％,两组比较差异均无统计学意义（P＞0.05）.在治疗相关不良反应方面,ENI组中肺V5、V20、肺平均剂量等指标均大于IFI组,比较差异均有统计学意义（=4.66、29.90、15.63,P＜0.05）;放射性肺炎的发生率ENI组明显高于IFI组,1～2级分别为22％和13％,3级分别为19％和4％,两组比较差异有统计学意义（x2=4.55、4.77,P＜0.05）.结论 在老年食管鳞癌单纯放疗患者中,IFI与ENI的疾病无进展生存率和生存率相似,IFI的肺受照射剂量明显减少,使肺的损伤更小,对老年患者更为适合.

英文摘要：

Objective To assess the outcomes of involved field irradiation （IFI） and elective nodal irradiation （ENI） in patients older than 70 years with esophageal squamous-cell carcinoma（SCC） receiving radical IMRT,and to determine whether IFI is feasible in these patients.Methods Totally 79 patients older than 70 years diagnosed with SCC of esophagus without distant metastases were collected.48 patients were received IFI,and the other 31 patients were treated with ENI.With a median follow-up time of 24 months,disease-free survival,overall survival,patterns of failure,irradiated lung dose and radiation pneumonitis were observed and compared between IFI and ENI groups.Results In IFI and ENI arm,the disease-free survival rates of 1,2,3 years were 60.4%,34.9%,29.7% and 64.5%,54.0%,35.0%,respectively（P 〉0.05）.The 1-,2-,and 3-year survival rates were 72.9%,43.4%,31.5% for the IFI arm,and 73.0%,53.0%,38.3% for the ENI arm（P 〉 0.05）.The ENI arm had a tendency to expand survival,but the two arms had no significant difference （P 〉 0.05）.The patterns of failure also had no difference between the two arms.Distant failure,local failure,uninvolved nodal failure in IFI arm were 22.9%,27.0%,4.2%,while in ENI arm were 25.8%,0,19.4%,all of them had no significant difference （P 〉 0.05）.However,the lung V5,V20,mean lung dose in ENI arm were higher than that in IFI and all of them had a significantly difference （t =4.66,29.90,15.63,P 〈 0.05）.The radiation pneumonitis rates were higher in ENI than in IFI arm.The rates of degree 1-2 and degree 3 were 22%,19%,and 13% and 4% in the two arms,respectively,with a significantly difference（x2 =4.55,4.77,P 〈 0.05）.Conclusions It is feasible that IFI for definitive IMRT in the elderly patients older than 70 years with SCC,because it got similar disease-free survival and overall survival but with less lung doses along with decreased radio-pulmonary lesion when compared with ENI.