Welsch Julia, Kup Philipp Günther, Nieder Carsten, Khosrawipour Veria, Bühler Helmut, Adamietz Irenäus A, Fakhrian Khashayar
1. Department of Radiation Oncology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany.
2. Department of Oncology and Palliative Medicine, Nordland Hospital Bodø, Norway; 3. Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Norway.
J Cancer. 2016 Jan 1;7(2):125-30. doi: 10.7150/jca.13655. eCollection 2016.
The aim of this study was to assess the 6-months dysphagia-free survival, improvement in swallowing function, complication rate, and overall survival in patients with incurable esophageal cancer treated with palliative radiotherapy.
We retrospectively reviewed data from 139 patients (median age 72 years) with advanced/recurrent incurable esophageal cancer, who were referred to 3 German radiation oncology centers for palliative radiotherapy between 1994 and 2014. Radiotherapy consisted of external beam radiotherapy (EBRT) with 30 - 40.5 Gy/2.5 - 3 Gy per fraction, brachytherapy alone (BT) with 15 - 25 Gy/5 - 7Gy per fraction/weekly and EBRT + BT (30 - 40.5 Gy plus 10 - 14 Gy with BT) in 65, 46, and 28 patients, respectively. Dysphagia-free survival (Dy-PFS) was defined as the time to worsening of dysphagia for at least one point, a new loco-regional failure or death of any cause.
Median follow-up time was 6 months (range 1-6 months). Subjective symptom relief was achieved in 72 % of patients with median response duration of 5 months. The 1-year survival rate was 30%. The 6-months Dy-PFS time for the whole group was 73 ± 4%. The 6-months Dy-PFS was 90 ± 4% after EBRT, 92 ± 5% after EBRT + BT and 37 ± 7% after BT, respectively (p<0.001). Five patients lived for more than 2 years, all of them were treated with EBRT ± BT. Ulceration, fistula and stricture developed in 3, 6 and 7 patients, respectively.
Radiotherapy leads to symptom improvement in the majority of patients with advanced incurable esophageal cancer. The present results favor EBRT ± BT over BT alone. Due to the retrospective nature of this study, imbalances in baseline characteristics might have contributed to this finding, and further trials appear necessary.
本研究旨在评估接受姑息性放疗的不可治愈性食管癌患者6个月无吞咽困难生存期、吞咽功能改善情况、并发症发生率及总生存期。
我们回顾性分析了139例（中位年龄72岁）晚期/复发性不可治愈性食管癌患者的数据，这些患者于1994年至2014年间被转诊至3家德国放射肿瘤中心接受姑息性放疗。放疗包括外照射放疗（EBRT），每次分割剂量为30 - 40.5 Gy/2.5 - 3 Gy；单纯近距离放疗（BT），每次分割剂量为15 - 25 Gy/5 - 7 Gy/每周；以及EBRT + BT（30 - 40.5 Gy加BT的10 - 14 Gy），分别有65例、46例和28例患者接受相应治疗。无吞咽困难生存期（Dy - PFS）定义为吞咽困难至少加重1分、出现新的局部区域复发或因任何原因死亡的时间。
中位随访时间为6个月（范围1 - 6个月）。72%的患者主观症状得到缓解，中位缓解持续时间为5个月。1年生存率为30%。全组6个月Dy - PFS时间为73±4%。EBRT后6个月Dy - PFS为90±4%，EBRT + BT后为92±5%，BT后为37±7%（p<0.001）。5例患者存活超过2年，均接受了EBRT±BT治疗。分别有3例、6例和7例患者出现溃疡、瘘管和狭窄。
放疗可使大多数晚期不可治愈性食管癌患者的症状得到改善。目前的结果表明，EBRT±BT优于单纯BT。由于本研究的回顾性特点，基线特征的不平衡可能导致了这一结果，因此似乎有必要进行进一步的试验。
