Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
Clin Lung Cancer. 2018 Nov;19(6):e885-e891. doi: 10.1016/j.cllc.2018.08.012. Epub 2018 Aug 22.
Acute esophagitis is common after thoracic radiation therapy (TRT) given with chemotherapy for limited-stage small-cell lung cancer (LS SCLC). Although twice-daily TRT to 45 Gy in 30 fractions is considered standard, some clinicians are reluctant to use this schedule because of its perceived impracticality and risk of severe esophagitis. We reviewed a single-institution experience with severe (grade ≥ 3) esophagitis after TRT with chemotherapy for LS SCLC.
A total of 504 patients were identified as having received TRT (≥45 Gy) with platinum-containing chemotherapy for LS SCLC at MD Anderson Cancer Center in 1987 through 2012. Patients with complete or good partial response were offered prophylactic cranial irradiation. Esophagitis was scored retrospectively with the Common Terminology Criteria for Adverse Events, V3.0. Clinical variables were analyzed for possible association with acute grade ≥ 3 esophagitis.
At a median follow-up time of 23.9 months (range, 1.2-240.8 months), 103 (20%) patients had experienced grade ≥ 3 esophagitis. In univariate analysis, TRT dose ≥ 60 Gy was the only factor associated with severe esophagitis (odds ratio [OR], 1.84; 95% confidence interval [CI], 1.02-3.30; P = .043); use of twice-daily TRT was not (OR, 0.96; 95% CI, 0.61-1.52; P = .867). The significance of TRT to ≥ 60 Gy was maintained in multivariate Cox regression analysis adjusted for tumor size (OR, 1.91; 95% CI, 1.05-3.46; P = .034).
TRT to ≥ 60 Gy predicted acute severe esophagitis, but twice-daily fractionation did not. Standard-dose 45-Gy twice-daily TRT should not be avoided for fear of severe esophagitis.
化疗联合胸部放疗（TRT）治疗局限期小细胞肺癌（LS SCLC）后，常发生急性食管炎。虽然将 TRT 剂量分割为 2 次/天，每次 45Gy，共 30 次，被认为是标准治疗方案，但由于其实施的不切实际性和发生严重食管炎的风险，一些临床医生不愿采用该方案。我们回顾了本机构采用化疗联合 TRT 治疗 LS SCLC 后发生严重（≥3 级）食管炎的经验。
1987 年至 2012 年，MD 安德森癌症中心共 504 例 LS SCLC 患者接受了含铂化疗联合 TRT（≥45Gy）治疗。完全或部分缓解的患者行预防性颅脑照射。采用通用不良事件术语标准，V3.0 版对食管炎进行回顾性评分。分析临床变量与急性≥3 级食管炎的可能相关性。
中位随访时间为 23.9 个月（范围，1.2-240.8 个月），103 例（20%）患者发生≥3 级食管炎。单因素分析显示，TRT 剂量≥60Gy 是严重食管炎的唯一相关因素（比值比 [OR]，1.84；95%置信区间 [CI]，1.02-3.30；P=0.043）；2 次/天的 TRT 应用（OR，0.96；95%CI，0.61-1.52；P=0.867）与严重食管炎无关。多因素 Cox 回归分析调整肿瘤大小后，TRT 剂量≥60Gy 仍具有统计学意义（OR，1.91；95%CI，1.05-3.46；P=0.034）。
TRT 剂量≥60Gy 预测急性严重食管炎，但 2 次/天的分割方法不预测严重食管炎。不应因担心发生严重食管炎而避免采用标准剂量 45Gy、2 次/天的 TRT。
