Coia L R, Minsky B D, Berkey B A, John M J, Haller D, Landry J, Pisansky T M, Willett C G, Hoffman J P, Owen J B, Hanks G E
Department of Radiation Oncology, Community Medical Center, Toms River, NJ 08755, USA.
J Clin Oncol. 2000 Feb;18(3):455-62. doi: 10.1200/JCO.2000.18.3.455.
A Patterns of Care Study examined the records of patients with esophageal cancer (EC) treated with radiation in 1992 through 1994 to determine the national practice processes of care and outcomes and to compare the results with those of clinical trials.
A national survey of 63 institutions was conducted using two-stage cluster sampling, and specific information was collected on 400 patients with squamous cell (62%) or adenocarcinoma (37%) of the thoracic esophagus who received radiation therapy (RT) as part of primary or adjuvant treatment. Patients were staged according to a modified 1983 American Joint Committee on Cancer staging system. Fifteen percent of patients had clinical stage (CS) I disease, 40% had CS II disease, and 30% had CS III disease. Twenty-six percent of patients underwent esophagectomy. Seventy-five percent of patients received chemotherapy; 84% of these received concurrent chemotherapy and radiation (CRT).
Significant variables for overall survival in multivariate analysis include the use of esophagectomy (risk ratio [RR] = 0.62), the use of chemotherapy (RR = 0.63), Karnofsky performance status (KPS) greater than 80 (RR = 0.61), CS I or II disease (RR = 0.66), and facility type (RR = 0.72). Age, sex, and histology were not significant. Preoperative CRT resulted in a nonsignificantly higher 2-year survival rate compared with definitive CRT alone (63% v 39%; P =.11), whereas 2-year survival by planned treatment rather than treatment given was 47.7% for preoperative CRT and 35.4% for definitive CRT (P =.23). Definitive CRT compared with definitive RT alone resulted in significantly higher 2-year survival (39% v 20.6%; P =.027) and lower 2-year local regional failure (30% v 57.9%; P =. 0031).
This study confirms the value of CRT in EC treatment. It indicates that the results obtained in practice settings nationwide are similar to those obtained in clinical trials and that KPS and the 1983 clinical staging system are useful prognostic indicators. The suggested value of esophagectomy and superiority of preoperative CRT over CRT alone in this study should be tested in a randomized trial.
一项治疗模式研究分析了1992年至1994年接受放射治疗的食管癌(EC)患者的记录,以确定全国的治疗实践过程和结果,并将结果与临床试验结果进行比较。
采用两阶段整群抽样法对63家机构进行了全国性调查,收集了400例胸段食管鳞状细胞癌(62%)或腺癌(37%)患者的具体信息,这些患者接受放射治疗(RT)作为主要或辅助治疗的一部分。根据改良的1983年美国癌症联合委员会分期系统对患者进行分期。15%的患者为临床I期疾病,40%为II期疾病,30%为III期疾病。26%的患者接受了食管切除术。75%的患者接受了化疗;其中84%接受了同步化疗和放疗(CRT)。
多变量分析中总生存的显著变量包括食管切除术的使用(风险比[RR]=0.62)、化疗的使用(RR=0.63)、卡诺夫斯基功能状态(KPS)大于80(RR=0.61)、I期或II期疾病(RR=0.66)以及机构类型(RR=0.72)。年龄、性别和组织学无显著意义。与单纯根治性CRT相比,术前CRT的2年生存率略高(63%对39%;P=0.11),而按计划治疗而非实际给予的治疗计算,术前CRT的2年生存率为47.7%,根治性CRT为35.4%(P=0.23)。与单纯根治性放疗相比,根治性CRT导致2年生存率显著提高(39%对20.6%;P=0.027),2年局部区域失败率降低(30%对57.9%;P=0.0031)。
本研究证实了CRT在EC治疗中的价值。表明在全国实际环境中获得的结果与临床试验中获得的结果相似,并且KPS和1983年临床分期系统是有用的预后指标。本研究中食管切除术的建议价值以及术前CRT优于单纯CRT的结果应在随机试验中进行验证。