Mackley Heath B, Adelstein Jonathan S, Reddy Chandana A, Adelstein David J, Rice Thomas W, Saxton Jerrold P, Videtic Gregory M M
Division of Radiation Oncology, Penn State Cancer Institute, Hershey, PA, USA.
J Gastrointest Cancer. 2008;39(1-4):130-7. doi: 10.1007/s12029-009-9067-x. Epub 2009 May 1.
Three-dimensional computed tomography-based radiotherapy planning (3DCTP) is increasingly employed in the treatment of esophageal cancer. It is unknown whether a 3DCTP approach influences outcomes compared to two-dimensional planning (2DP). This study compares clinical outcomes for homogeneously treated patient cohorts stratified by planning modality.
A retrospective chart review was conducted on patients with T3/4 and/or node-positive esophageal carcinoma treated at the Cleveland Clinic between July 1, 2003 and May 31, 2006 who were managed with an institutional regimen consisting of preoperative radiotherapy, whether 3DCTP or 2DP [30 Gy/20 fractions/1.5 Gy twice daily over 2 weeks], with concurrent cisplatin and 5-fluorouracil the first week. Following definitive resection, an identical postoperative course of concurrent chemoradiotherapy (CRT) was delivered.
One hundred and forty-one patients completed preoperative CRT and were available for review. The median follow-up of living patients is 21.7 months. Fifty-five percent underwent 3DCTP and 45% had 2DP. The treatment groups were similar, with the exception of clinical stage group, with 2DP having more stage II and fewer stage III patients than 3DCTP (p = 0.02). 3DCTP plans had significantly smaller field sizes by area (p < 0.0001). Pathologic response, locoregional control, distant control, and overall survival were equivalent between the two planning modalities. Esophagitis was significantly less common with a 3D approach compared to 2D planning (49% vs. 71%, p = 0.0096), with other toxicities equivalent between the groups.
3DCTP reduces acute esophagitis in patients receiving multimodality therapy for esophageal cancer without compromising clinical outcomes.
基于三维计算机断层扫描的放射治疗计划（3DCTP）在食管癌治疗中的应用日益广泛。与二维计划（2DP）相比，3DCTP方法是否会影响治疗结果尚不清楚。本研究比较了按计划方式分层的同质治疗患者队列的临床结果。
对2003年7月1日至2006年5月31日在克利夫兰诊所接受治疗的T3/4和/或淋巴结阳性食管癌患者进行回顾性病历审查，这些患者采用由术前放疗组成的机构方案进行治疗，无论是3DCTP还是2DP[30 Gy/20次分割/1.5 Gy，每日两次，共2周]，并在第一周同时使用顺铂和5-氟尿嘧啶。在根治性切除后，进行相同的术后同步放化疗（CRT）疗程。
141例患者完成了术前CRT并可供审查。存活患者的中位随访时间为21.7个月。55%的患者接受了3DCTP，45%的患者接受了2DP。治疗组相似，但临床分期组除外，2DP组的II期患者比3DCTP组多，III期患者比3DCTP组少（p = 0.02）。3DCTP计划的照射野面积明显更小（p < 0.0001）。两种计划方式在病理反应、局部区域控制、远处控制和总生存率方面相当。与2D计划相比，3D方法引起的食管炎明显较少见（49%对71%，p = 0.0096），两组之间的其他毒性相当。
3DCTP可降低接受多模式治疗的食管癌患者的急性食管炎发生率，且不影响临床结果。
