Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München, München, Germany.
Department of Oncology and Palliative Medicine, Nordland Hospital Trust, Bodø, and Institute of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway.
Anticancer Res. 2014 Dec;34(12):7255-61.
This study was undertaken to examine the impact of radiation dose on pathological complete response (pCR) rates following neoadjuvant radiochemotherapy (N-RCT) for squamous cell esophageal cancer (ESCC).
From 1988 to 2011, 218 patients were treated with 30-30.6 Gy (1.8-2 Gy per fraction), 39.6-40 Gy (1.8-2 Gy per fraction) or 44-45 Gy (1.8-2 Gy per fraction) and concomitant cisplatin ± 5-fluorouracil (5-FU), oxaliplatin + 5-FU or 5-FU alone. The most commonly used concomitant chemotherapy was continuous infusion of 5-FU-alone with a dose of 300 mg/m(2)/day during the whole course of treatment (n=111). To eliminate the dispersing effect of potentially different efficacy levels of these drug regimens on pCR, we excluded patients with regimens other than 5-FU-alone.
Histomorphological regression grade 1a (0% residual tumor), 1b (<10% residual tumor), 2 (10-50% residual tumor) and 3 (>50% residual tumor) was observed in 26 (23%), 24 (22%), 36 (32%) and 25 (23%) patients, respectively. pCR was observed in 9 out of 71 (13%) patients treated with 30 Gy-30.6 Gy, 13 of 34 (38%) patients treated with 39.6-40 Gy and 4 of 6 (67%) patients treated with 44-45 Gy (p=0.001). Median follow-up time from the start of N-RCT was 191 months (range=2-262 months). The estimated 5-year overall survival (OS) was 33% for the whole cohort. OS at 5 years was 58% for patients with pCR compared to 25% for patients with less favorable response to N-RCT (p=0.009), respectively.
The dose of radiation correlates significantly with the likelihood of achieving a pCR in stage II/III squamous cell esophageal cancer patients. Prospective randomized trials are required to definitively evaluate the impact of application of higher radiation doses on efficacy and safety/tolerability in the context of N-RCT on the clinical outcomes.
本研究旨在探讨新辅助放化疗（N-RCT）后不同放射剂量对鳞状细胞食管癌（ESCC）患者病理完全缓解（pCR）率的影响。
1988 年至 2011 年，218 例患者接受 30-30.6Gy（1.8-2Gy/次）、39.6-40Gy（1.8-2Gy/次）或 44-45Gy（1.8-2Gy/次）放射治疗，并联合顺铂±5-氟尿嘧啶（5-FU）、奥沙利铂+5-FU 或 5-FU 单药治疗。最常用的联合化疗是在整个治疗过程中持续输注 5-FU 单药，剂量为 300mg/m²/天（n=111）。为消除这些药物方案的潜在不同疗效水平对 pCR 的分散作用，我们排除了非 5-FU 单药方案的患者。
组织形态学缓解分级 1a（0%残余肿瘤）、1b（<10%残余肿瘤）、2（10-50%残余肿瘤）和 3（>50%残余肿瘤）分别见于 26（23%）、24（22%）、36（32%）和 25（23%）例患者。71 例接受 30Gy-30.6Gy 治疗的患者中，9 例（13%）达到 pCR；34 例接受 39.6-40Gy 治疗的患者中，13 例（38%）达到 pCR；6 例接受 44-45Gy 治疗的患者中，4 例（67%）达到 pCR（p=0.001）。从 N-RCT 开始到中位随访时间为 191 个月（范围 2-262 个月）。全队列的 5 年总生存率（OS）为 33%。pCR 患者的 5 年 OS 为 58%，而 N-RCT 反应较差的患者为 25%（p=0.009）。
放射剂量与 II/III 期鳞状细胞食管癌患者达到 pCR 的可能性显著相关。需要前瞻性随机试验来明确评估在 N-RCT 背景下应用更高放射剂量对疗效和安全性/耐受性的影响，以改善临床结局。
