调强放疗同步化疗对颈段食管癌患者生存的影响。
Effect of Intensity Modulated Radiation Therapy With Concurrent Chemotherapy on Survival for Patients With Cervical Esophageal Carcinoma.
机构信息
Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada.
Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada.
出版信息
Int J Radiat Oncol Biol Phys. 2017 May 1;98(1):186-195. doi: 10.1016/j.ijrobp.2017.01.003. Epub 2017 Jan 9.
PURPOSE
We evaluated the effect of consecutive protocols on overall survival (OS) for cervical esophageal carcinoma (CEC).
METHODS AND MATERIALS
All CEC cases that received definitive radiation therapy (RT) with or without chemotherapy from 1997 to 2013 in 3 consecutive protocols were reviewed. Protocol 1 (P1) consisted of 2-dimensional RT of 54 Gy in 20 fractions with 5-fluorouracil plus either mitomycin C or cisplatin. Protocol 2 (P2) consisted of 3-dimensional conformal RT (3DRT) of ≥60 Gy in 30 fractions plus elective nodal irradiation plus cisplatin. Protocol 3 (P3) consisted of intensity modulated RT (IMRT) of ≥60 Gy in 30 fractions plus elective nodal irradiation plus cisplatin. Multivariable analyses were used to assess the effect of the treatment protocol, RT technique, and RT dose on OS, separately.
RESULTS
Of 81 cases (P1, 21; P2, 23; and P3, 37), 34 local (P1, 11 [52%]; P2, 12 [52%]; and P3, 11 [30%]), 16 regional (P1, 6 [29%]); P2, 3 [13%]; and P3, 7 [19%]), and 34 distant (P1, 10 [48%]; P2, 9 [39%]; and P3, 15 [41%]) failures were identified. After adjusting for age (P=.49) and chemotherapy (any vs none; hazard ratio [HR] 0.5, 95% confidence interval [CI] 0.3-0.9; P=.023), multivariable analysis showed P3 had improved OS compared with P1 (HR 0.4, 95% CI 0.2-0.8; P=.005), with a trend shown for benefit compared with P2 (HR 0.6, 95% CI 0.3-1.0; P=.061). OS between P1 and P2 did not differ (P=.29). Analyzed as a continuous variable, higher RT doses were associated with a borderline improved OS (HR 0.97, 95% CI 0.95-1.0; P=.075). IMRT showed improved OS compared with non-IMRT (HR 0.57, 95% CI 0.3-0.8; P=.008).
CONCLUSIONS
The present retrospective consecutive cohort study showed improved OS with our current protocol (P3; high-dose IMRT with concurrent high-dose cisplatin) compared with historical protocols. The outcomes for patients with CEC remain poor, and novel approaches to improve the therapeutic ratio are warranted.
目的
我们评估了连续方案对颈段食管癌（CEC）总生存（OS）的影响。
方法和材料
回顾了 1997 年至 2013 年 3 个连续方案中接受根治性放疗（RT）联合或不联合化疗的所有 CEC 病例。方案 1（P1）包括 20 个 54Gy 的二维 RT，联合氟尿嘧啶加丝裂霉素 C 或顺铂。方案 2（P2）包括≥60Gy 的三维适形 RT（3DRT），加选择性淋巴结照射加顺铂。方案 3（P3）包括≥60Gy 的调强放疗（IMRT），加选择性淋巴结照射加顺铂。采用多变量分析分别评估治疗方案、RT 技术和 RT 剂量对 OS 的影响。
结果
在 81 例患者中（P1 21 例，P2 23 例，P3 37 例），34 例局部（P1 11 例[52%]，P2 12 例[52%]，P3 11 例[30%]），16 例区域（P1 6 例[29%]，P2 3 例[13%]，P3 7 例[19%]）和 34 例远处（P1 10 例[48%]，P2 9 例[39%]，P3 15 例[41%]）转移失败。调整年龄（P=.49）和化疗（任何 vs 无；风险比[HR]0.5，95%置信区间[CI]0.3-0.9；P=.023）后，多变量分析显示 P3 组的 OS 优于 P1 组（HR 0.4，95%CI 0.2-0.8；P=.005），与 P2 组相比也有获益趋势（HR 0.6，95%CI 0.3-1.0；P=.061）。P1 与 P2 组的 OS 无差异（P=.29）。作为连续变量进行分析，更高的 RT 剂量与 OS 略有改善相关（HR 0.97，95%CI 0.95-1.0；P=.075）。与非调强放疗相比，调强放疗显示出改善的 OS（HR 0.57，95%CI 0.3-0.8；P=.008）。
结论
本回顾性连续队列研究显示，与历史方案相比，我们目前的方案（P3；高剂量调强放疗联合同期高剂量顺铂）改善了颈段食管癌患者的 OS。CEC 患者的预后仍然较差，需要新的方法来提高治疗比率。
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