Freilich J, Hoffe S E, Almhanna K, Dinwoodie W, Yue B, Fulp W, Meredith K L, Shridhar R
Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida, USA.
Dis Esophagus. 2015 May-Jun;28(4):352-7. doi: 10.1111/dote.12203. Epub 2014 Mar 17.
Emerging data suggests a benefit for using intensity modulated radiation therapy (IMRT) for the management of esophageal cancer. We retrospectively reviewed patients treated at our institution who received definitive or preoperative chemoradiation with either IMRT or 3D conformal radiation therapy (3DCRT) between October 2000 and January 2012. Kaplan Meier analysis and the Cox proportional hazard model were used to evaluate survival outcomes. We evaluated a total of 232 patients (138 IMRT, 94 3DCRT) who received a median dose of 50.4 Gy (range, 44-64.8) to gross disease. Median follow up for all patients, IMRT patients alone, and 3DCRT patients alone was 18.5 (range, 2.5-124.2), 16.5 (range, 3-59), and 25.9 months (range, 2.5-124.2), respectively. We observed no significant difference based on radiation technique (3DCRT vs. IMRT) with respect to median overall survival (OS) (median 29 vs. 32 months; P = 0.74) or median relapse free survival (median 20 vs. 25 months; P = 0.66). On multivariable analysis (MVA), surgical resection resulted in improved OS (HR 0.444; P < 0.0001). Superior OS was also associated on MVA with stage I/II disease (HR 0.523; P = 0.010) and tumor length ≤5 cm (HR 0.567; P = 0.006). IMRT was also associated on univariate analysis with a significant decrease in acute weight loss (mean 6% + 4.3% vs 9% + 7.4%, P = 0.012) and on MVA with a decrease in objective grade ≥3 toxicity, defined as any hospitalization, feeding tube, or >20% weight loss (OR 0.51; P = 0.050). Our data suggest that while IMRT-based chemoradiation for esophageal cancer does not impact survival there was significantly less toxicity. In the IMRT group there was significant decrease in weight loss and grade ≥3 toxicity compared to 3DCRT.
新出现的数据表明，使用调强放射治疗（IMRT）治疗食管癌有益。我们回顾性分析了2000年10月至2012年1月期间在我院接受确定性或术前放化疗的患者，这些患者接受了IMRT或三维适形放射治疗（3DCRT）。采用Kaplan-Meier分析和Cox比例风险模型评估生存结果。我们共评估了232例患者（138例接受IMRT，94例接受3DCRT），对大体肿瘤给予的中位剂量为50.4 Gy（范围44-64.8 Gy）。所有患者、仅接受IMRT的患者以及仅接受3DCRT的患者的中位随访时间分别为18.5个月（范围2.5-124.2个月）、16.5个月（范围3-59个月）和25.9个月（范围2.5-124.2个月）。在中位总生存期（OS）（中位29个月对32个月；P = 0.74）或中位无复发生存期（中位20个月对25个月；P = 0.66）方面，我们未观察到基于放疗技术（3DCRT与IMRT）的显著差异。在多变量分析（MVA）中，手术切除可改善总生存期（HR 0.444；P < 0.0001）。在MVA中，I/II期疾病（HR 0.523；P = 0.010）和肿瘤长度≤5 cm（HR 0.567；P = 0.006）也与较好的总生存期相关。在单变量分析中，IMRT还与急性体重减轻显著减少相关（平均6% + 4.3%对9% + 7.4%，P = 0.012），在MVA中与客观≥3级毒性降低相关，定义为任何住院、放置饲管或体重减轻>20%（OR 0.51；P = 0.050）。我们的数据表明，虽然基于IMRT的食管癌放化疗不影响生存，但毒性显著降低。与3DCRT相比，IMRT组体重减轻和≥3级毒性显著降低。
