摘要目的 探讨食管癌根治性放化疗后局部复发患者的挽救治疗方法和疗效.方法 收集2002-2012年符合入组条件患者126例,分别接受挽救性手术、挽救性放化疗和姑息治疗.结果 全组126例患者中58例接受挽救性手术、52例行挽救性放化疗、16例接受了姑息治疗.接受挽救治疗者1、3、5年生存率分别为51％、16％、4％,接受姑息治疗者生存期均未达到1年(P＜0.001).挽救性手术和挽救性放化疗者1、3、5年生存率分别为48％、20％、7％与51％、11％、3％ (P=0.473).Cox模型多因素分析显示复发肿瘤T分期和挽救治疗方式为局部复发患者预后影响因素(P＜0.001).挽救性手术感染发生率16％,挽救性放化疗的食管气管瘘和食管纵隔瘘的发生率分别为10％和6％.结论 食管癌根治性放化疗后局部复发患者挽救治疗可带来生存获益,挽救性手术和挽救性放化疗均为可选方法,但应关注治疗并发症.

abstractsObjective To investigate the salvage strategy and efficacy for patients with locally recurrent esophageal squamous cell carcinoma after definitive radiochemotherapy.Methods A total of 126 patients who met the inclusion criteria were enrolled in this study and divided into the salvage surgery,salvage radiochemotherapy and best supportive care.Results Fifty-eight of 126 patients received salvage esophagectomy,52 underwent salvage radiochemotherapy and the remaining 16 patients received best supportive care.The 1-,3-,5-year overall survival rates of patients receiving salvage therapy were 51％,16％ and 4％ for the three groups,whereas all patients in the best supportive care group died within 12.0 months (P＜0.001).The 1-,3-,5-year survival rates in the salvage surgery and salvage radiochemotherapy groups were 48％,20％ and 7％,and 51％,11％ and 3％,respectively (P=0.473).Multivariate analysis by Cox proportional hazard model showed that T staging of recurrent tumors and salvage regimen were the independent prognostic factors in patients with locally recurrent esophageal cancer (both P＜ 0.001).Postoperative infection occurred in 16％ of the patients in the salvage surgery group,and the incidence of esophagotracheal fistula and mediastinoesophageal fistula was 10％ and 6％ in the salvage radiochemotherapy group.Conclusions A survival benefit can be elicited by salvage surgery or salvage radiochemotherapy in patients with locally recurrent esophageal cancer after definitive radiochemotherapy.Nevertheless,extensive attention should be paid to the management of postoperative complications in clinical practice.