基于肿瘤氟脱氧葡萄糖摄取量降低和正常组织限制的个体化放射剂量递增可提高食管癌患者的生存率。
Individualized Radiation Dose Escalation Based on the Decrease in Tumor FDG Uptake and Normal Tissue Constraints Improve Survival in Patients With Esophageal Carcinoma.
作者信息
Ma Jinbo, Wang Zhaoyang, Wang Chengde, Chen Ercheng, Dong Yaozong, Song Yipeng, Wang Wei, You Dong, Jiang Wei, Zang Rukun
机构信息
1 Department of Radiation Oncology, Yantai Yuhuangding Hospital, School of Medicine, Qingdao University, Yantai, China.
2 Department of Thoracic Surgery, Yantai Yuhuangding Hospital, School of Medicine, Qingdao University, Yantai, P.R. China.
出版信息
Technol Cancer Res Treat. 2017 Feb;16(1):75-80. doi: 10.1177/1533034615627583. Epub 2016 Jun 23.
BACKGROUND
To determine whether individualized radiation dose escalation after planned chemoradiation based on the decrease in tumor and normal tissue constraints can improve survival in patients with esophageal carcinoma.
METHODS
From August 2005 to December 2010, 112 patients with squamous esophageal carcinoma were treated with radical concurrent chemoradiation. Patients received positron emission tomography-computer tomography scan twice, before radiation and after radiation dose of 50.4 Gy. All patients were noncomplete metabolic response groups according to the Response Evaluation Criteria in solid tumors. Only 52 patients with noncomplete metabolic response received individualized dose escalation based on tumor and normal tissue constraints. Survival and treatment failure were observed and analyzed using SPSS (13.0).
RESULTS
The rate of complete metabolic response for patients with noncomplete metabolic response after dose escalation reached 17.3% (9 of 52). The 2-year overall survival rates for patients with noncomplete metabolic response in the conventional and dose-escalation groups were 20.5% and 42.8%, respectively( P = .001). The 2-year local control rates for patients were 35.7% and 76.2%, respectively ( P = .002). When patients were classified into partial metabolic response and no metabolic response, 2-year overall survival rates for patients with partial metabolic response were significantly different in conventional and dose-escalation groups (33.8% vs 78.4%; P = .000). The 2-year overall survival rates for patients with no metabolic response in two groups (8.6% vs 15.1%) did not significantly differ ( P = .917).
CONCLUSION
Individualized radiation dose escalation has the potential to improve survival in patients with esophageal carcinoma according to increased rate of complete metabolic response. However, further trials are needed to confirm this and to identify patients who may benefit from dose escalation.
背景
基于肿瘤和正常组织限制的降低，确定计划化放化疗后个体化放疗剂量递增是否能提高食管癌患者的生存率。
方法
2005年8月至2010年12月，112例食管鳞状细胞癌患者接受了根治性同步放化疗。患者在放疗前和放疗剂量达50.4 Gy后各接受一次正电子发射断层扫描-计算机断层扫描。根据实体瘤疗效评价标准，所有患者均为非完全代谢反应组。仅52例非完全代谢反应患者根据肿瘤和正常组织限制接受了个体化剂量递增。使用SPSS（13.0）观察并分析生存率和治疗失败情况。
结果
剂量递增后非完全代谢反应患者的完全代谢反应率达到17.3%（52例中的9例）。传统组和剂量递增组非完全代谢反应患者的2年总生存率分别为20.5%和42.8%（P = .001）。患者的2年局部控制率分别为35.7%和76.2%（P = .002）。当将患者分为部分代谢反应组和无代谢反应组时，传统组和剂量递增组中部分代谢反应患者的2年总生存率有显著差异（33.8%对78.4%；P = .000）。两组中无代谢反应患者的2年总生存率（8.6%对15.1%）无显著差异（P = .917）。
结论
根据完全代谢反应率的提高，个体化放疗剂量递增有可能提高食管癌患者的生存率。然而，需要进一步试验来证实这一点，并确定可能从剂量递增中获益的患者。
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