식도암에서 근치적 절제술 후 방사선치료의 역할

Abstract

Objective : A retrospective study was performed to evaluate whether postoperative adjuvant radiotherapy can improve survival and decrease recurrence as compared with surgery alone in resected esophageal cancer. Materials and Methods : From Jan. 1985 to Dec. 1993, among 94 esophageal cancer patients treated with surgery, fifty-one patients were included in this study. Transthoracic esophagectomy was performed in 35 patients and transhiatal esophagectomy in 16. Postoperative adjuvant radiotherapy was performed 4 weeks after surgery in 26 among 38 patients in stage Ⅱ and Ⅲ. A total does of 30~60 Gy in 1.8 Gy nodes or celiac lymph nodes according to the tumor location. Forty-seven patients(92%) had squamous histology. The median follow-up period was 38 months. Result : The overall 2-year and 5-year survival and median survival were 56.4%, 36.8 and 45 months. Two-year and 5-year survival and median survival by stage were 92%, 60.3% ofr stage Ⅰ, 63%, 42% and 51 months for stage Ⅱ and 34%, 23% and 19 months for stage Ⅲ(p=0.04). For stage Ⅱ and Ⅲ patients, 5-year survival and median survival were 22.8%, 45 months for the surgery alone group and 37.8%, 22 month for the postoperative RT group (p=0.89). For stage Ⅲ patients, 2-year survival and median survival were 0%, 11 months for the surgery alone group and 36.5%, 20 months for the postoperative RT group (p=0.14). Local and distant failure rates for stage Ⅱ and Ⅲ were 50%, 16% for the surgery alone and 39%, 31% for the postoperative RT group. For N1 patients, local failure rate was 71% for the surgery alone group and 37% for the postoperative RT group (p=0.19). Among 10 local failures in the post-operative RT group, in-field failures were 2, marginal failures 1, out-field 5 and anastomotic site failures 2. Conclusion : There were no statistically significant differences in either the overall survival or the patterns of failure between the surgery alone group and the postoperative RT group for resected stage Ⅱ and Ⅲ esophageal cancer. But this study showed a tendency of survival improvement and decrease in local failure when postoperative RT was performed for stage Ⅲ or N1 though statistically not significant. To decrease local failure, a more generous radiation field encompassing the supraclavicular, mediastinal, and celiac lymph nodes and anastomotic site in postoperative adjuvant treatment should be considered.