Zhang Wenyi, Li Huifang, Chen Xingxing, Su Meng, Lin Ruifang, Zou Changlin
1 Department of Radiotherapy and Chemotherapy, The First Affiliated Hospital of Wenzhou Medical University , Wenzhou , China.
2 Department of Cancer Chemotherapy and Radiotherapy, The Second Affiliated Hospital of Wenzhou Medical University , Wenzhou , China.
Br J Radiol. 2017 Aug;90(1077):20170328. doi: 10.1259/bjr.20170328. Epub 2017 Jul 27.
A Phase II study was designed to test the safety and efficacy of concurrent chemoradiotherapy with a modified target volumes delineation method for inoperable oesophageal cancer patients.
All eligible patients were treated with concurrent chemoradiotherapy. The method of delineating target volume is as follows: Planning gross target volume (PGTV) was defined as the primary gross tumour volume (GTV-t) plus a 3 cm margin longitudinally and a 0.5 cm margin circumferentially, and positive lymph nodes(GTV-n) plus a 0.5 cm margin in all directions. Clinical target volume (CTV) was defined as PGTV plus a 0.5 cm margin in all directions and elective nodal region. Planning target volume (PTV) was defined as CTV plus a 0.5 cm margin in all directions. The dose of PGTV is 54-60 Gy in 27-30 fractions(2Gy per fraction). The dose of PTV is 48.6-54 Gy in 27-30 fractions(1.8Gy per fraction). The regimen consists of paclitaxel135 mgm on 1 day and DDP 25 mgm on 3 days per 3 weeks. The patients received 2 cycles of chemotherapy during radiotherapy and 2-4 cycles of chemotherapy after radiotherapy.
34 patients were enrolled in this study. The median follow-up time was 20.9 months (range: 3.7-28.4 months) for all patients. The 1- and 2-year survival rates for all patients were 70.5 and 44.1%, respectively. Clinical complete response was observed in 21 patients(61.8%), cPR was observed in 9 patients(26.5%) and cSD was observed in 4 patients(11.7%).
This modified method with concurrent chemotherapy could achieve better locoregional control rate. The 1- and 2-year survival rates of this method were close to the survival rates of the current methods widely adopted. Advances in knowledge: The modified target volumes delineation method can enhance locoregional control rate of concurrent chemoradiotherapy.
开展一项II期研究，以测试采用改良靶区勾画方法的同步放化疗对无法手术的食管癌患者的安全性和疗效。
所有符合条件的患者均接受同步放化疗。靶区勾画方法如下：计划大体肿瘤体积（PGTV）定义为原发大体肿瘤体积（GTV-t）纵向加3 cm边界、周向加0.5 cm边界，以及阳性淋巴结（GTV-n）各方向加0.5 cm边界。临床靶体积（CTV）定义为PGTV各方向加0.5 cm边界以及选择性淋巴结区域。计划靶体积（PTV）定义为CTV各方向加0.5 cm边界。PGTV剂量为54 - 60 Gy，分27 - 30次（每次2 Gy）。PTV剂量为48.6 - 54 Gy，分27 - 30次（每次1.8 Gy）。治疗方案为每3周第1天给予紫杉醇135 mg/m²，第3天给予顺铂25 mg/m²。患者在放疗期间接受2周期化疗，放疗后接受2 - 4周期化疗。
本研究共纳入34例患者。所有患者的中位随访时间为20.9个月（范围：3.7 - 28.4个月）。所有患者的1年和2年生存率分别为70.5%和44.1%。21例患者（61.8%）观察到临床完全缓解，9例患者（26.5%）观察到临床部分缓解，4例患者（11.7%）观察到疾病稳定。
这种改良方法联合同步化疗可实现更好的局部区域控制率。该方法的1年和2年生存率接近目前广泛采用方法的生存率。知识进展：改良靶区勾画方法可提高同步放化疗的局部区域控制率。
