Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, China; Department of Radiation Oncology, Fudan University Shanghai Cancer Center, China; Department of Oncology, Shanghai Medical College, Fudan University, China.
Department of Radiation Oncology, Fudan University Shanghai Cancer Center, China; Department of Oncology, Shanghai Medical College, Fudan University, China.
Radiother Oncol. 2015 Feb;114(2):195-200. doi: 10.1016/j.radonc.2014.12.007. Epub 2015 Jan 10.
To observe the safety of selective dose boost to the pre-treatment high (18)F-deoxyglucose (FDG) uptake areas of the esophageal GTV.
Patients with esophageal squamous cell carcinoma were treated with escalating radiation dose of 4 levels, with a simultaneous integrated boost (SIB) to the pre-treatment 50% SUVmax area of the primary tumor. Patients received 4 monthly cycles of cisplatin and fluorouracil. Dose-limiting toxicity (DLT) was defined as any Grade 3 or higher acute toxicities causing continuous interruption of radiation for over 1 week.
From April 2012 to February 2014, dose has been escalated up to LEVEL 4 (70Gy). All of the 25 patients finished the prescribed dose without DLT, and 10 of them developed Grade 3 acute esophagitis. One patient of LEVEL 2 died of esophageal hemorrhage within 1 month after completion of radiotherapy, which was not definitely correlated with treatment yet. Late toxicities remained under observation. With median follow up of 8.9months, one-year overall survival and local control was 69.2% and 77.4%, respectively.
Dose escalation in esophageal cancer based on (18)FDG-PET/CT has been safely achieved up to 70Gy using the SIB technique. Acute toxicities were well tolerated, whereas late toxicities and long-term outcomes deserved further observation.
观察对食管 GTV 预处理高（18）F-脱氧葡萄糖（FDG）摄取区进行选择性剂量递增的安全性。
对患有食管鳞癌的患者采用 4 个递增放射剂量水平进行治疗，同时对原发肿瘤的预处理 50%SUVmax 区域进行同步整合增敏（SIB）。患者接受 4 个周期的顺铂和氟尿嘧啶治疗。剂量限制毒性（DLT）定义为任何 3 级或更高级别的急性毒性反应，导致放射治疗中断超过 1 周。
从 2012 年 4 月至 2014 年 2 月，剂量已递增至第 4 级（70Gy）。所有 25 例患者均完成了规定剂量，无 DLT，其中 10 例发生 3 级急性食管炎。1 例 2 级患者在放疗完成后 1 个月内死于食管出血，但与治疗无明确相关性。晚期毒性仍在观察中。中位随访 8.9 个月后，1 年总生存率和局部控制率分别为 69.2%和 77.4%。
基于（18）FDG-PET/CT 的食管癌剂量递增，采用 SIB 技术已安全达到 70Gy。急性毒性反应可耐受，而晚期毒性和长期结果需要进一步观察。
