Venkat P S, Shridhar R, Naghavi A O, Hoffe S E, Almhanna K, Pimiento J M, Fontaine J-P, Abuodeh Y, Meredith K L, Frakes J M
Departments of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
Florida Hospital Cancer Institute, Department of Radiation Oncology, Orlando, Fl, USA.
Dis Esophagus. 2017 Jul 1;30(7):1-9. doi: 10.1093/dote/dox036.
We compared pathologic complete response (pCR) rate, toxicity, and postoperative complications between patients treated preoperatively with 50.4 Gy versus dose escalation with dose-painting intensity-modulated radiation therapy (dp-IMRT) to 56 Gy in locally advanced esophageal cancer. We evaluated esophageal cancer patients treated between 2006 and 2014 with preoperative IMRT chemoradiation to a dose of 50.4 Gy versus 56 Gy. The endpoints were pCR and toxicity. We identified 113 patients (50.4 Gy: n = 40; 56 Gy: n = 73). There were no significant differences in tumor or patient characteristics. Patients treated with 56 Gy demonstrated a higher pCR rate (56.2% vs. 30.0%) and lower pathologic nonresponse rate (4.1% vs. 20.0%) compared to patients treated to 50.4 Gy (P = 0.008). This remained significant on multivariate analysis (OR 3.375 95%CI 1.3-8.8, P = 0.013). Patients treated to 56 Gy also had an improved 3-year locoregional control rate compared to those treated to 50.4 Gy (93.8% vs. 78.5%; P = 0.022). The estimated 3-year freedom from failure was also superior in the 56 Gy arm (73.7% vs. 52.2%; P = 0.051), approaching significance. There were no differences in treatment related grade ≥3 toxicities, hospital admissions, feeding tube, esophageal stent placement, or dilation. There was, however, a statistically significant increase in postoperative atrial fibrillation in patients treated with 56 Gy (30.1% vs. 12.5%; P = 0.036). There was no difference in postoperative 30 or 60 day mortality. Dose escalation to 56 Gy with dp-IMRT is safe and results in significantly higher complete pathologic response rates in esophageal cancer without an increase in treatment-related toxicity. Prospective trials using dp-IMRT are needed to address the role of dose escalation on pCR rate and survival in esophageal cancer.
我们比较了局部晚期食管癌患者术前接受50.4 Gy放疗与采用剂量调强放疗（dp-IMRT）剂量递增至56 Gy后的病理完全缓解（pCR）率、毒性反应及术后并发症。我们评估了2006年至2014年间接受术前IMRT同步放化疗，剂量为50.4 Gy与56 Gy的食管癌患者。观察终点为pCR和毒性反应。我们纳入了113例患者（50.4 Gy组：n = 40；56 Gy组：n = 73）。肿瘤或患者特征方面无显著差异。与接受50.4 Gy治疗的患者相比，接受56 Gy治疗的患者pCR率更高（56.2% 对30.0%），病理无反应率更低（4.1% 对20.0%）（P = 0.008）。多因素分析显示这一差异仍具有显著性（OR 3.375，95%CI 1.3 - 8.8，P = 0.013）。与接受50.4 Gy治疗的患者相比，接受56 Gy治疗的患者3年局部区域控制率也有所提高（93.8% 对78.5%；P = 0.022）。56 Gy组的估计3年无失败生存率也更高（73.7% 对52.2%；P = 0.051），接近显著性差异。治疗相关的≥3级毒性反应、住院、饲管置入、食管支架置入或扩张方面无差异。然而，接受56 Gy治疗患者的术后房颤发生率有统计学显著增加（30.1% 对12.5%；P = 0.036）。术后30天或60天死亡率无差异。采用dp-IMRT将剂量递增至56 Gy是安全的，且能使食管癌患者的病理完全缓解率显著提高，同时不会增加治疗相关毒性。需要进行前瞻性试验以探讨剂量递增对食管癌pCR率和生存率的作用。
