Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Radiation Oncology, Cancer Center, Sun Yat-sen University, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangzhou, Guangdong, China.
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Radiation Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
Int J Radiat Oncol Biol Phys. 2017 Nov 1;99(3):667-676. doi: 10.1016/j.ijrobp.2017.06.2450. Epub 2017 Jun 27.
To compare clinical outcomes between proton beam therapy (PBT) and intensity modulated radiation therapy (IMRT) in patients with esophageal cancer (EC) treated with definitive chemoradiotherapy (CRT).
From 2007 through 2014, 343 EC patients who received definitive CRT with either PBT (n=132) or IMRT (n=211) were retrospectively analyzed. Survival, recurrence, and treatment toxicity were compared between groups. A Cox proportional hazards regression model was performed to test the association between patient/treatment variables and survival.
Patient/treatment variables were overall well balanced, except for age and race. Compared with IMRT, PBT had significantly better overall survival (OS; P=.011), progression-free survival (PFS; P=.001), distant metastasis-free survival (DMFS; P=.031), as well as marginally better locoregional failure-free survival (LRFFS; P=.075). No significant differences in rates of treatment-related toxicities were observed between groups. On multivariate analysis, IMRT had worse OS (hazard ratio [HR] 1.454; P=.01), PFS (HR 1.562; P=.001), and LRFFS (HR 1.461; P=.041) than PBT. Subgroup analysis by clinical stage revealed considerably higher 5-year OS (34.6% vs 25.0%, P=.038) and PFS rates (33.5% vs 13.2%, P=.005) in the PBT group for patients with stage III disease. However, no significant intergroup differences in survival were identified for stage I/II patients.
Compared with IMRT, PBT might be associated with improved OS, PFS, and LRFFS, especially in EC patients with locally advanced disease. These results need confirmation by prospective studies.
比较质子束治疗（PBT）和调强放疗（IMRT）在接受根治性放化疗（CRT）的食管癌（EC）患者中的临床结果。
回顾性分析了 2007 年至 2014 年间，343 例接受根治性 CRT 的 EC 患者，其中 132 例接受 PBT，211 例接受 IMRT。比较了两组患者的生存、复发和治疗毒性。采用 Cox 比例风险回归模型检测患者/治疗变量与生存的相关性。
患者/治疗变量总体上平衡良好，除了年龄和种族。与 IMRT 相比，PBT 的总生存率（OS；P=.011）、无进展生存率（PFS；P=.001）、无远处转移生存率（DMFS；P=.031）以及局部区域无复发生存率（LRFFS；P=.075）显著更好。两组间治疗相关毒性发生率无显著差异。多变量分析显示，IMRT 的 OS（风险比 [HR] 1.454；P=.01）、PFS（HR 1.562；P=.001）和 LRFFS（HR 1.461；P=.041）均较 PBT 差。临床分期亚组分析显示，PBT 组 III 期患者的 5 年 OS（34.6%比 25.0%，P=.038）和 PFS 率（33.5%比 13.2%，P=.005）显著更高。然而，对于 I/II 期患者，两组之间的生存无显著差异。
与 IMRT 相比，PBT 可能与改善 OS、PFS 和 LRFFS 相关，尤其是在局部晚期 EC 患者中。这些结果需要前瞻性研究证实。
