Department of Radiation Oncology, Western University, London Regional Cancer Program Room A3-810 Ed and Irene Fregin Building 790 Commissioners Road E, N6A-4L6, London, ON, Canada.
Radiat Oncol. 2013 Feb 11;8:33. doi: 10.1186/1748-717X-8-33.
Multimodality therapy leads to improved outcomes for adenocarcinoma of the distal esophagus and gastroesophageal junction (GEJ) over surgery alone. At our institution, adjuvant chemoradiation (chemoRT) using IMRT and SIB is standard of care for resected high-risk disease. In this study, we review our experience with a recent cohort of patients treated in this manner.
We identified 18 patients with resected T3 and/or N1 adenocarcinoma of the distal esophagus and GEJ who received adjuvant chemoRT. A large elective volume (PTV1) and a smaller high-risk volume (PTV2) were irradiated simultaneously using IMRT and an SIB technique. All patients received concurrent chemotherapy. Relevant clinical outcomes are reported.
The median dose to 95% of PTV1 was 3747cGy and to 95% of PTV2 was 4876cGy. All RT was given in a median of 28 daily fractions. Four patients did not complete chemotherapy. At a median follow up of 952 days from the start of RT, 7 of 18 patients were dead; of these, 3 had developed local recurrence only; 3 had developed both local and distant recurrence; 1 died of a late toxicity, without recurrence. OS was 88% at 1year, 76% at 2 years and 58% at 3 years. Freedom from local recurrence was 88% at 1 year, 82% at 2 years and 82% at 3 years. Freedom from distant recurrence was 72% at 1 year, 67% at 2 years and 56% at 3 years. Toxicity was acceptable.
Adjuvant concurrent chemoRT with IMRT and SIB is feasible for resected high-risk adenocarcinoma of the distal esophagus and GEJ. Our results describe how modern treatment techniques can be employed as part of a treatment paradigm that is neither commonly used nor commonly described in the literature.
与单纯手术相比，多模态治疗可改善远端食管和胃食管交界处（GEJ）腺癌的预后。在我们的机构中，对于切除的高危疾病，使用调强放疗（chemoRT）和 SIB 的辅助化疗是标准治疗。在这项研究中，我们回顾了最近一组采用这种方法治疗的患者的经验。
我们确定了 18 名接受辅助 chemoRT 治疗的 T3 和/或 N1 远端食管和 GEJ 腺癌切除患者。使用调强放疗和 SIB 技术同时照射大的选择性靶区（PTV1）和较小的高危靶区（PTV2）。所有患者均接受同步化疗。报告了相关的临床结果。
PTV1 的 95%剂量中位数为 3747cGy，PTV2 的 95%剂量中位数为 4876cGy。所有 RT 均在 28 个每日分割中完成。有 4 名患者未完成化疗。在从 RT 开始的中位随访 952 天后，18 名患者中有 7 名死亡；其中，3 名仅出现局部复发；3 名出现局部和远处复发；1 名死于晚期毒性，无复发。1 年时的 OS 为 88%，2 年时为 76%，3 年时为 58%。1 年时的无局部复发率为 88%，2 年时为 82%，3 年时为 82%。1 年时的无远处复发率为 72%，2 年时为 67%，3 年时为 56%。毒性是可以接受的。
对于切除的高危远端食管和 GEJ 腺癌，使用调强放疗和 SIB 的辅助同步化疗是可行的。我们的结果描述了如何使用现代治疗技术作为治疗模式的一部分，这种治疗模式既不常用，也不常见于文献中。
