Li Qi-Wen, Zhu Yu-Jia, Zhang Wen-Wen, Yang Han, Liang Yao, Hu Yong-Hong, Qiu Bo, Liu Meng-Zhong, Liu Hui
Departments of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China.
Departments of Thoracic Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China.
J Cancer. 2017 Feb 11;8(4):563-569. doi: 10.7150/jca.17408. eCollection 2017.
: To evaluate the efficacy and toxicity of concurrent chemoradiotherapy (CRT) in multiple primary cancers (MPC) of the upper digestive tract in esophageal squamous cell carcinoma (ESCC). : In a screening of 1193 consecutive patients diagnosed with ESCC and received radiotherapy, 53 patients presenting synchronous MPC in the upper digestive tract were retrospectively investigated. 53 consecutive patients with esophageal non-multiple primary cancer (NPC), matched by stage, age and sex, served as control. All of the patients received concurrent CRT. The median radiation dose was 60 Gy. Chemotherapy regimens were based on platinum and/or 5-fluorouracil. Clinical outcomes and treatment toxicities were compared. : Clinic-pathologic characteristics were well balanced between groups. MPC mostly located in esophagus (43, 81.8%), followed by hypopharynx (8, 15.1%) and stomach (2, 3.8%). In MPC and NPC patients, 94.3% and 96.2% completed the intended treatment. The immediate response rate was 73.6% 75.5%, with complete response rate of 11.3% 24.5% and partial response rate of 62.3% 51.0%. Two-year overall survival (OS), progression-free survival (PFS), locoregional progression-free survival (LRPFS) and distant progression-free survival (DPFS) were 52.2% 68.9% (=0.026), 32.9% 54.0% (=0.032), 60.8% 87.8% (=0.002) and 64.0% 70.8% (=0.22), respectively. Acute grade 3-4 toxicities were observed in 64.2% 54.7%, significantly higher in radiation esophagitis (49.1% 28.3%, <0.001), and mucositis (11.3% 00=0.027). : Compared with matched NPC, ESCC accompanied with synchronous MPC was related to significantly impaired survival, elevated risk of locoregional disease progression and higher incidence of severe esophagitis and mucositis, following concurrent chemoradiotherapy. Future study on reasons for decreased efficacy of chemoradiotherapy will help to optimize treatment. Advanced radiation techniques may play a role in protecting normal tissues and reduce acute toxicities.
评估同步放化疗（CRT）治疗食管鳞状细胞癌（ESCC）上消化道多原发性癌（MPC）的疗效和毒性。：在对1193例连续诊断为ESCC并接受放疗的患者进行的筛查中，对53例上消化道出现同步MPC的患者进行了回顾性研究。53例连续的食管非多原发性癌（NPC）患者，按分期、年龄和性别匹配，作为对照。所有患者均接受同步CRT。中位放疗剂量为60 Gy。化疗方案以铂类和/或5-氟尿嘧啶为基础。比较临床结果和治疗毒性。：两组间临床病理特征均衡。MPC大多位于食管（43例，81.8%），其次是下咽（8例，15.1%）和胃（2例，3.8%）。在MPC和NPC患者中，94.3%和96.2%完成了预定治疗。即刻缓解率分别为73.6%和75.5%，完全缓解率为11.3%和24.5%，部分缓解率为62.3%和51.0%。两年总生存（OS）、无进展生存（PFS）、局部区域无进展生存（LRPFS）和远处无进展生存（DPFS）分别为52.2%和68.9%（P=0.026）、32.9%和54.0%（P=0.032）、60.8%和87.8%（P=0.002）以及64.0%和70.8%（P=0.22）。3-4级急性毒性在64.2%和54.7%的患者中观察到，放射性食管炎（49.1%和28.3%，P<0.001）和粘膜炎（11.3%和0.0%，P=0.027）显著更高。：与匹配的NPC相比，ESCC伴同步MPC与生存显著受损、局部区域疾病进展风险升高以及同步放化疗后严重食管炎和粘膜炎发生率更高相关。未来对放化疗疗效降低原因的研究将有助于优化治疗。先进的放疗技术可能在保护正常组织和降低急性毒性方面发挥作用。
