Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-chou, Aoba-ku, Sendai, 980-8574, Japan.
Department of Radiology, Toho University Omori Medical Center, Tokyo, Japan.
Radiat Oncol. 2017 Sep 5;12(1):146. doi: 10.1186/s13014-017-0882-0.
Neoadjuvant chemoradiotherapy following surgery has recently become a standard therapy. The purpose of the present study was to determine the effectiveness and toxicity of re-irradiation for oligo-recurrence in lymph nodes from esophageal cancer treated by definitive radiotherapy or by surgery with additional radiotherapy.
We reviewed retrospectively 248 patients treated with (chemo)radiotherapy for oligo-recurrence in lymph nodes from esophageal cancer in five Japanese high-volume centers between 2000 and 2015. Thirty-three patients in whom re-irradiation was performed were enrolled in this study, and the results for patients in whom re-irradiation was performed were compared with the results for other patients.
Median maximum lymph node diameter was 22 mm. Median total radiation dose was 60 Gy. The median calculated biological effective dose using the LQ model with α/β = 10 Gy (BED10) in patients in whom re-irradiation was performed was significantly lower than the median BED10 in others. There was no different factor except for BED10, histology and irradiation field between patients with a past irradiation history and patients without a past irradiation history. The median observation period in surviving patients in whom re-irradiation was performed was 21.7 months. The 3-year overall survival rate in the 33 patients with a past irradiation history was 17.9%, with a median survival period of 16.0 months. Overall survival rate and local control rate in patients with a past irradiation history were significantly worse than those in patients without a past irradiation history (log-rank test, p = 0.016 and p = 0.0007, respectively). One patient in whom re-irradiation was performed died from treatment-related gastric hemorrhage.
Results in the present study suggested that re-irradiation for oligo-recurrence in lymph nodes from esophageal cancer treated by definitive radiotherapy or by surgery with additional radiotherapy might be acceptable but unsatisfactory.
新辅助放化疗（neoadjuvant chemoradiotherapy）继手术之后，已成为标准疗法。本研究的目的在于明确在接受根治性放疗或手术联合放疗的食管癌寡复发淋巴结患者中，再次放疗的有效性和毒性。
我们回顾性分析了 2000 年至 2015 年期间，在日本五个大容量中心接受（放）化疗治疗食管癌寡复发淋巴结的 248 例患者。其中 33 例患者接受了再次放疗，将这组患者的结果与未行再次放疗的患者的结果进行比较。
中位最大淋巴结直径为 22mm。中位总放疗剂量为 60Gy。接受再次放疗患者的 LQ 模型中位计算生物有效剂量（BED10）显著低于未接受再次放疗患者的 BED10。除了 BED10、组织学和照射野外，有放疗史患者与无放疗史患者之间无其他差异因素。接受再次放疗患者中存活患者的中位观察期为 21.7 个月。33 例有放疗史患者的 3 年总生存率为 17.9%，中位生存时间为 16.0 个月。有放疗史患者的总生存率和局部控制率明显低于无放疗史患者（对数秩检验，p=0.016 和 p=0.0007）。1 例接受再次放疗的患者死于治疗相关性胃出血。
本研究结果表明，对于接受根治性放疗或手术联合放疗的食管癌寡复发淋巴结患者，再次放疗可能是可以接受的，但效果并不理想。
