Ge Xiaolin, Yang Xi, Lu Xiaohu, Wen Wei, Zhen Fuxi, Ye Hongxun, Zhu Hongcheng, Cao Yuandong, Zhang Sheng, Cheng Hongyan, Ma Jianxin, Yang Baixia, Dai Shengbin, Guo Qing, Cai Jing, Sun Xinchen
Department of Radiotherapy, The First Affiliated Hospital of Nanjing Medical University, Nanjing - China.
Tumori. 2015 Mar-Apr;101(2):168-73. doi: 10.5301/tj.5000234. Epub 2015 Mar 16.
This study evaluated the effectiveness and safety of intensity-modulated radiation therapy (IMRT) for locally advanced esophageal squamous cell carcinoma (ESCC).
Between August 2009 and December 2011, 112 patients with pathologically confirmed ESCC treated with IMRT at Jiangsu Province People's Hospital and Nantong Tumor Hospital were included in a retrospective analysis. Patients received either IMRT alone (group A) or concurrent chemoradiotherapy (CRT) (group B). A radiation dose of 60-66 Gy administered in 30-33 fractions was delivered to the tumor. The patients in group B simultaneously received 2 cycles of cisplatin-based doublets with either 5-fluorouracil or taxotere. The Kaplan-Meier method was used to compute the survival time. Early and late toxicities were scored according to CTCAE v.3.0.
The response rate of group B (91.07%) was not significantly greater than that of group A (89.29%) (χ2 = 0.10, p = 0.75). The 1- and 3-year survival rates of group B (87.5% and 57.14%, respectively) were greater than those of group A (69.64% and 37.50%, respectively). The difference in overall survival was statistically significant between groups A and B (χ2 = 5.30, p = 0.02; χ2 = 4.33, p = 0.04). Hematological toxicity, gastrointestinal toxicity, and treatment-related esophagitis were significantly higher in group B than group A (16.07% vs. 33.93%, p = 0.04; 10.71% vs. 26.79%, p = 0.03; 19.64% vs. 44.64%, p = 0.01). However, intergroup differences in terms of late toxicity were not significant.
IMRT was a practical and feasible technique to treat ESCC. Concurrent CRT could increase local tumor control and long-term survival. The CRT regimen was associated with a higher incidence of acute gastrointestinal and hematological toxicity.
本研究评估调强放射治疗（IMRT）用于局部晚期食管鳞状细胞癌（ESCC）的有效性和安全性。
2009年8月至2011年12月期间，对江苏省人民医院和南通肿瘤医院接受IMRT治疗的112例经病理确诊的ESCC患者进行回顾性分析。患者接受单纯IMRT（A组）或同步放化疗（CRT）（B组）。向肿瘤给予60 - 66 Gy的放射剂量，分30 - 33次给予。B组患者同时接受2周期基于顺铂的双联化疗，联合5-氟尿嘧啶或多西他赛。采用Kaplan-Meier法计算生存时间。根据CTCAE v.3.0对早期和晚期毒性进行评分。
B组的缓解率（91.07%）并不显著高于A组（89.29%）（χ2 = 0.10，p = 0.75）。B组的1年和3年生存率（分别为87.5%和57.14%）高于A组（分别为69.64%和37.50%）。A组和B组之间的总生存差异具有统计学意义（χ2 = 5.30，p = 0.02；χ2 = 4.33，p = 0.04）。B组的血液学毒性、胃肠道毒性和治疗相关食管炎显著高于A组（16.07%对33.93%，p = 0.04；10.71%对26.79%，p = 0.03；19.64%对44.64%，p = 0.01）。然而，组间晚期毒性差异不显著。
IMRT是治疗ESCC的一种实用可行的技术。同步CRT可提高局部肿瘤控制率和长期生存率。CRT方案与更高的急性胃肠道和血液学毒性发生率相关。
