Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Int J Radiat Oncol Biol Phys. 2013 Aug 1;86(5):885-91. doi: 10.1016/j.ijrobp.2013.04.006.
While trimodality therapy for esophageal cancer has improved patient outcomes, surgical complication rates remain high. The goal of this study was to identify modifiable factors associated with postoperative complications after neoadjuvant chemoradiation.
From 1998 to 2011, 444 patients were treated at our institution with surgical resection after chemoradiation. Postoperative (pulmonary, gastrointestinal [GI], cardiac, wound healing) complications were recorded up to 30 days postoperatively. Kruskal-Wallis tests and χ(2) or Fisher exact tests were used to assess associations between continuous and categorical variables. Multivariate logistic regression tested the association between perioperative complications and patient or treatment factors that were significant on univariate analysis.
The most frequent postoperative complications after trimodality therapy were pulmonary (25%) and GI (23%). Lung capacity and the type of radiation modality used were independent predictors of pulmonary and GI complications. After adjusting for confounding factors, pulmonary and GI complications were increased in patients treated with 3-dimensional conformal radiation therapy (3D-CRT) versus intensity modulated radiation therapy (IMRT; odds ratio [OR], 2.018; 95% confidence interval [CI], 1.104-3.688; OR, 1.704; 95% CI, 1.03-2.82, respectively) and for patients treated with 3D-CRT versus proton beam therapy (PBT; OR, 3.154; 95% CI, 1.365-7.289; OR, 1.55; 95% CI, 0.78-3.08, respectively). Mean lung radiation dose (MLD) was strongly associated with pulmonary complications, and the differences in toxicities seen for the radiation modalities could be fully accounted for by the MLD delivered by each of the modalities.
The radiation modality used can be a strong mitigating factor of postoperative complications after neoadjuvant chemoradiation.
尽管食管癌的三联疗法改善了患者的预后，但手术并发症发生率仍然很高。本研究的目的是确定与新辅助放化疗后术后并发症相关的可改变因素。
1998 年至 2011 年，我们机构对 444 例接受放化疗后手术切除的患者进行了治疗。术后（肺部、胃肠道[GI]、心脏、伤口愈合）并发症在术后 30 天内记录。Kruskal-Wallis 检验和 χ(2)或 Fisher 确切概率检验用于评估连续变量和分类变量之间的关系。多变量逻辑回归检验了围手术期并发症与单变量分析中显著的患者或治疗因素之间的关系。
三联疗法后最常见的术后并发症是肺部（25%）和胃肠道（23%）。肺容量和使用的放射治疗方式是肺部和胃肠道并发症的独立预测因素。调整混杂因素后，与调强适形放射治疗（IMRT）相比，接受三维适形放射治疗（3D-CRT）治疗的患者肺部和胃肠道并发症增加（比值比[OR]，2.018；95%置信区间[CI]，1.104-3.688；OR，1.704；95% CI，1.03-2.82），与质子束治疗（PBT）相比，接受 3D-CRT 治疗的患者肺部和胃肠道并发症也增加（OR，3.154；95% CI，1.365-7.289；OR，1.55；95% CI，0.78-3.08）。平均肺辐射剂量（MLD）与肺部并发症密切相关，每种放射治疗方式的毒性差异可完全由各方式的 MLD 来解释。
放射治疗方式是新辅助放化疗后术后并发症的一个重要缓解因素。
