Jingu Keiichi, Umezawa Rei, Yamamoto Takaya, Matsushita Haruo, Ishikawa Youjirou, Kozumi Maiko, Kubozono Masaki, Takahashi Noriyoshi, Kadoya Noriyuki, Takeda Ken
Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Japan.
Jpn J Clin Oncol. 2017 Mar 1;47(3):200-205. doi: 10.1093/jjco/hyw195.
The purposes of the present study were to evaluate prognostic factors for patients with postoperative loco-regional recurrent esophageal cancer treated with chemoradiotherapy by multivariate analysis and to determine which irradiation is better, involved field irradiation or elective nodal irradiation, by matched-pair analysis.
We reviewed records for 80 patients with postoperative loco-regional recurrent esophageal cancer treated by chemoradiotherapy between 2000 and 2014. The median follow-up period was 62.0 months. Thirty-one cases were treated with elective nodal irradiation and were randomly matched by risk factors to 49 cases treated with involved field irradiation (1:1).
Fifty-one patients had disease recurrence again, and irradiated-field failure was observed in 26 patients. The 5-year overall survival rate was 30.5% with a median survival period of 26.5 months. Grade 3 or higher late toxicity was observed in only one patient. In multivariate analysis, short disease-free interval and anastomotic recurrence were statistically significant unfavorable prognostic factors for overall survival (hazard ratios: 2.1 and 2.5, respectively). Matched-pair analysis including disease-free interval, pattern of recurrence and number of recurrent regions revealed that overall survival rate and irradiated-field control rate in patients treated with involved field irradiation were significantly better than those in patients treated with elective nodal irradiation (P = 0.016 and P = 0.014, respectively).
Short disease-free interval and anastomotic recurrence are unfavorable factors and elective nodal irradiation is not necessary in chemoradiotherapy for patients with postoperative loco-regional recurrent esophageal cancer.
本研究旨在通过多因素分析评估接受放化疗的术后局部区域复发性食管癌患者的预后因素，并通过配对分析确定哪种照射方式更好，即累及野照射或选择性淋巴结照射。
我们回顾了2000年至2014年间80例接受放化疗的术后局部区域复发性食管癌患者的记录。中位随访期为62.0个月。31例接受选择性淋巴结照射，并根据危险因素与49例接受累及野照射的患者随机配对（1:1）。
51例患者再次出现疾病复发，26例观察到照射野失败。5年总生存率为30.5%，中位生存期为26.5个月。仅1例患者观察到3级或更高等级的晚期毒性。在多因素分析中，无病间期短和吻合口复发是总生存的统计学显著不良预后因素（风险比分别为2.1和2.5）。包括无病间期、复发模式和复发区域数量的配对分析显示，接受累及野照射的患者的总生存率和照射野控制率显著优于接受选择性淋巴结照射的患者（P分别为0.016和0.014）。
无病间期短和吻合口复发是不利因素，术后局部区域复发性食管癌患者的放化疗中不需要选择性淋巴结照射。
