目的:探讨Ⅳ期食管癌患者行不同剂量放射治疗后生存率等指标的差异。方法:选择成都军区总医院2006年1月至2009年4月44例接受过高剂量或低剂量放疗,并均行同步化疗的Ⅳ期食管癌患者,回顾性分析其生存率、急性放射性损伤发生率等指标,并分析影响生存的相关因素。结果:高剂量放疗组总有效率及局控率明显高于低剂量组(P<0.01);高剂量组1年总生存率(overall survival rate,OS)为63.6%,2年和3年OS分别为40.1%和7.7%;低剂量组1、2、3年OS分别为41.9%、10.9%、1.4%,整体比较提示高剂量组生存时间较低剂量组延长(P=0.003);OS与年龄、放疗方式、烟酒史相关(P<0.001)。放射性损伤发生率:肺损伤、骨髓抑制组间无差异,食管炎高剂量较低剂量组明显增加。结论:治疗前PS评分≤1的Ⅳ期食管癌患者行高剂量放疗可明显提高局控、总有效率与OS;年龄≤60岁,行高剂量放疗及无烟酒史的患者总生存受益更多;行高剂量放疗患者放射性损伤的发生率在临床可接受范围。 Objective: To investigate the difference of survival rate of patients with stage Ⅳ esophageal cancer under different doses of radiotherapy. Methods: A total of 44 patients with stage Ⅳ esophageal cancer who underwent high-dose or low-dose radiotherapy from January 2006 to April 2009 in Chengdu Military Region General Hospital were retrospectively analyzed for their survival rate and acute radiation injury Rate and other indicators, and analyze the impact of factors related to survival. Results: The total effective rate and the control rate in high-dose radiotherapy group were significantly higher than those in low-dose radiotherapy group (P <0.01). The overall 1-year survival rate was 63.6% in high-dose radiotherapy group and 2 and 3 years in OS 40.1% and 7.7% respectively; the 1, 2, 3-year OS was 41.9%, 10.9% and 1.4% respectively in the low-dose group. The overall comparison showed that the survival time of the high dose group was longer than that of the low dose group (P = 0.003) Age, radiation therapy, smoking and drinking history (P <0.001). The incidence of radioactive injury: lung injury, bone marrow suppression was no difference between groups, esophagitis high dose lower dose group was significantly increased. Conclusion: Patients with stage Ⅳ esophageal cancer with PS score less than or equal to 1 before treatment may have better overall survival benefit with high-dose radiotherapy. The overall survival rate is better in patients with OS ≤60 years and undergoing high-dose radiotherapy and alcohol-free alcoholic therapy The incidence of radiation injury in high-dose radiotherapy patients is within the clinically acceptable range.