Lv Shiliang, Fang Min, Yang Jia, Zhan Wenming, Jia Yongshi, Xu Hong'en, Song Tao
Department of Radiotherapy, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, People's Republic of China.
Onco Targets Ther. 2016 Sep 6;9:5389-97. doi: 10.2147/OTT.S107668. eCollection 2016.
The aim of this study was to investigate the efficiency and safety of using S-1 as monotherapy and maintenance therapy combined with definitive concurrent radiotherapy for elderly patients with esophageal cancer.
From January 2009 to December 2010, 68 elderly patients were included. Radiotherapy was delivered with a daily fraction of 1.8-2.0 Gy to a total radiation dose of 54.0-60.0 Gy. Preplanned concurrent S-1 (80 mg/m(2)/d) was given on days 1-14, every 3 weeks. After concurrent chemoradiotherapy, maintenance S-1 was repeated up to four cycles.
The median age of the enrolled patients was 76 years (range: 70-88 years), and the clinical stages were stage I (two patients), stage II (24 patients), stage III (28 patients), and stage IV (14 patients). A total of 51 (75.0%) patients finished treatment on schedule, with a median of five cycles of S-1, in which 35 (51.5%) patients achieved complete response. The median follow-up time was 42.7 months, and the median overall survival (OS) and progression-free survival (PFS) times were 25.7 months and 21.5 months, respectively. The 1-year, 3-year, and 5-year OS and PFS rates were 70.6%, 41.8%, and 25.9% and 68.1%, 32.9%, and 15.9%, respectively. Grade ≥3 neutropenia and leukopenia were found in 14 patients and 13 patients, respectively. The most common nonhematologic toxicity was esophagitis including six patients and one patient with grades 3 and 4, respectively. Multivariate analysis revealed that cycles of S-1 and complete response were strong factors for OS and PFS.
For geriatric patients with esophageal cancer, S-1 as monotherapy and maintenance chemotherapy in combination with definitive concurrent radiation therapy yielded satisfactory survival outcomes with tolerable toxicities. More studies are highly warranted to further clarify this issue.
本研究旨在探讨S-1单药治疗及维持治疗联合根治性同步放疗用于老年食管癌患者的有效性和安全性。
纳入2009年1月至2010年12月期间的68例老年患者。放疗每日分次剂量为1.8 - 2.0 Gy，总辐射剂量为54.0 - 60.0 Gy。预先计划在第1 - 14天同步给予S-1（80 mg/m²/d），每3周重复一次。同步放化疗后，维持使用S-1最多重复4个周期。
入组患者的中位年龄为76岁（范围：70 - 88岁），临床分期为Ⅰ期（2例患者）、Ⅱ期（24例患者）、Ⅲ期（28例患者）和Ⅳ期（14例患者）。共有51例（75.0%）患者按计划完成治疗，S-1的中位周期数为5个周期，其中35例（51.5%）患者达到完全缓解。中位随访时间为42.7个月，中位总生存期（OS）和无进展生存期（PFS）分别为25.7个月和21.5个月。1年、3年和5年的OS率和PFS率分别为70.6%、41.8%、25.9%和68.1%、32.9%、15.9%。分别有14例和13例患者出现≥3级中性粒细胞减少和白细胞减少。最常见的非血液学毒性是食管炎，分别有6例和1例患者出现3级和4级食管炎。多因素分析显示，S-1的周期数和完全缓解是OS和PFS的重要因素。
对于老年食管癌患者，S-1单药治疗及维持化疗联合根治性同步放疗可产生令人满意的生存结果，且毒性可耐受。非常有必要进行更多研究以进一步阐明这一问题。
