Ordu Arif Deniz, Nieder Carsten, Geinitz Hans, Kup Philipp Günther, Deymann Lisa Felicia, Scherer Vera, Combs Stephanie E, Fakhrian Khashayar
Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München, München, Germany.
Strahlenther Onkol. 2015 Feb;191(2):153-60. doi: 10.1007/s00066-014-0779-x. Epub 2014 Nov 18.
The purpose of this work is to report the long-term outcomes of three-dimensional conformal radio(chemo)therapy in the curative management of esophageal squamous cell carcinoma (ESCC).
A retrospective analysis of patients treated with radio(chemo)therapy between 1988 and 2011 at Klinikum rechts der Isar, Technische Universität München was performed. In all, 168 patients received radio(chemo)therapy for ESCC in curative intention. The median follow-up time was 91 months (range 1-212 months). There were 128 men and 40 women with a median age of 63 years. Selection criteria for radio(chemo)therapy were unfit for surgery and/or unresectable primary tumor (n = 146, 87 %) or patients' choice (n = 22, 13 %). The majority of the patients received a combination of cisplatin and 5-fluorouracil chemotherapy with 54 Gy in 30 fractions of radiotherapy.
The median overall survival (OS) was 20 months (95 % confidence interval 17-23 months). The OS at 2 and 5 years for the whole cohort was 41 ± 4 % and 22 ± 3 %, respectively. Forty patients (24 %) suffered an in-field recurrence. The most common acute nonhematologic toxicity >grade 2 was dysphagia in 35 % of the patients. Acute hematologic toxicity > grade 2 was recorded in 14 % of the patients. There was no grade 5 toxicity observed during the study. Poor ECOG performance status (0-1 vs. 2-3, HR = 1.70, p = 0.002) and weight loss ≥ 10 % before the start of therapy (HR = 1.99, p = 0.001) were among the factors significantly associated with poor OS in multivariate analysis.
Three-dimensional conformal definitive radio(chemo)therapy is well tolerated and leads to long-term survival in more than 20 % of patients with advanced disease and/or contraindication to surgery. However, 24 % in-field recurrence remains a major concern. Prospective trials are warranted to assess if a well-tailored conformal radiochemotherapy can improve the local control and obviate the need for surgical resection in patients with good general condition and potentially resectable tumors.
本研究旨在报告三维适形放射（化学）治疗在食管鳞状细胞癌（ESCC）根治性治疗中的长期疗效。
对1988年至2011年在慕尼黑工业大学伊萨尔河右岸医院接受放射（化学）治疗的患者进行回顾性分析。共有168例患者接受了ESCC的根治性放射（化学）治疗。中位随访时间为91个月（范围1 - 212个月）。其中男性128例，女性40例，中位年龄63岁。放射（化学）治疗的选择标准为不适合手术和/或原发性肿瘤不可切除（n = 146，87%）或患者选择（n = 22，13%）。大多数患者接受了顺铂和5 - 氟尿嘧啶化疗联合54 Gy分30次的放射治疗。
中位总生存期（OS）为20个月（95%置信区间17 - 23个月）。整个队列2年和5年的OS分别为41±4%和22±3%。40例患者（24%）出现野内复发。最常见的>2级急性非血液学毒性是35%的患者出现吞咽困难。14%的患者记录有>2级急性血液学毒性。研究期间未观察到5级毒性。多因素分析中，较差的ECOG体能状态（0 - 1 vs. 2 - 3，HR = 1.70，p = 0.002）和治疗开始前体重减轻≥10%（HR = 1.99，p = 0.001）是与较差OS显著相关的因素。
三维适形根治性放射（化学）治疗耐受性良好，可使超过20%的晚期疾病和/或手术禁忌患者获得长期生存。然而，24%的野内复发仍是一个主要问题。有必要进行前瞻性试验，以评估精心定制的适形放化疗是否能改善局部控制并避免对一般状况良好且肿瘤可能可切除患者进行手术切除的必要性。
