Lin Steven H, Merrell Kenneth W, Shen Jincheng, Verma Vivek, Correa Arlene M, Wang Lu, Thall Peter F, Bhooshan Neha, James Sarah E, Haddock Michael G, Suntharalingam Mohan, Mehta Minesh P, Liao Zhongxing, Cox James D, Komaki Ritsuko, Mehran Reza J, Chuong Michael D, Hallemeier Christopher L
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, United States.
Department of Radiation Oncology, Mayo Clinic, Rochester, United States.
Radiother Oncol. 2017 Jun;123(3):376-381. doi: 10.1016/j.radonc.2017.04.013. Epub 2017 Apr 25.
Relative radiation dose exposure to vital organs in the thorax could influence clinical outcomes in esophageal cancer (EC). We assessed whether the type of radiation therapy (RT) modality used was associated with postoperative outcomes after neoadjuvant chemoradiation (nCRT).
Contemporary data from 580 EC patients treated with nCRT at 3 academic institutions from 2007 to 2013 were reviewed. 3D conformal RT (3D), intensity modulated RT (IMRT) and proton beam therapy (PBT) were used for 214 (37%), 255 (44%), and 111 (19%) patients, respectively. Postoperative outcomes included pulmonary, GI, cardiac, wound healing complications, length of in-hospital stay (LOS), and 90-day postoperative mortality. Cox model fits, and log-rank tests both with and without Inverse Probability of treatment Weighting (IPW) were used to correct for bias due to non-randomization.
RT modality was significantly associated with the incidence of pulmonary, cardiac and wound complications, which also bore out on multivariate analysis. Mean LOS was also significantly associated with treatment modality (13.2days for 3D (95%CI 11.7-14.7), 11.6days for IMRT (95%CI 10.9-12.7), and 9.3days for PBT (95%CI 8.2-10.3) (p<0.0001)). The 90day postoperative mortality rates were 4.2%, 4.3%, and 0.9%, respectively, for 3D, IMRT and PBT (p=0.264).
Advanced RT technologies (IMRT and PBT) were associated with significantly reduced rate of postoperative complications and LOS compared to 3D, with PBT displaying the greatest benefit in a number of clinical endpoints. Ongoing prospective randomized trial will be needed to validate these results.
胸部重要器官的相对辐射剂量暴露可能会影响食管癌（EC）的临床结局。我们评估了新辅助放化疗（nCRT）后使用的放射治疗（RT）方式类型是否与术后结局相关。
回顾了2007年至2013年期间在3家学术机构接受nCRT治疗的580例EC患者的当代数据。分别有214例（37%）、255例（44%）和111例（19%）患者使用了三维适形放疗（3D）、调强放疗（IMRT）和质子束治疗（PBT）。术后结局包括肺部、胃肠道、心脏、伤口愈合并发症、住院时间（LOS）和术后90天死亡率。使用Cox模型拟合以及有无治疗逆概率加权（IPW）的对数秩检验来校正非随机化导致的偏差。
RT方式与肺部、心脏和伤口并发症的发生率显著相关，多因素分析也证实了这一点。平均LOS也与治疗方式显著相关（3D为13.2天（95%CI 11.7 - 14.7），IMRT为11.6天（95%CI 10.9 - 12.7），PBT为9.3天（95%CI 8.2 - 10.3）（p<0.0001））。3D、IMRT和PBT的术后90天死亡率分别为4.2%、4.3%和0.9%（p = 0.264）。
与3D相比，先进的RT技术（IMRT和PBT）与术后并发症发生率和LOS显著降低相关，PBT在多个临床终点显示出最大益处。需要进行正在进行的前瞻性随机试验来验证这些结果。
