Radiotherapy Research Group, Leeds Cancer Centre, The Leeds Teaching Hospitals NHS Trust, Leeds, UK; School of Molecular & Cellular Biology, Faculty of Biological Sciences, University of Leeds, Leeds, UK; Leeds Institute of Medical Research at St James's, Faculty of Medicine & Health, University of Leeds, Leeds, UK.
Radiotherapy Research Group, Leeds Cancer Centre, The Leeds Teaching Hospitals NHS Trust, Leeds, UK; Leeds Institute of Medical Research at St James's, Faculty of Medicine & Health, University of Leeds, Leeds, UK; Leeds Institute of Health Sciences, Faculty of Medicine & Health, University of Leeds, Leeds, UK.
Clin Oncol (R Coll Radiol). 2019 Jun;31(6):356-364. doi: 10.1016/j.clon.2019.01.010. Epub 2019 Feb 5.
Chemoradiotherapy (CRT) is established as a superior treatment option to definitive radiotherapy in the non-surgical management of oesophageal cancer. For patients precluded from CRT through choice or comorbidity there is little evidence to guide delivery of single-modality radiotherapy. In this study we outline outcomes for patients unfit for CRT who received a hypofractionated radiotherapy (HRT) regimen.
A retrospective UK single-centre analysis of 61 consecutive patients with lower- or middle-third adenocarcinoma (OAC; 61%) or squamous cell carcinoma of the oesophagus managed using HRT with radical intent between April 2009 and 2014. Treatment consisted of 50 Gy in 16 fractions (n = 49, 80.3%) or 50-52.5 Gy in 20 fractions (n = 12, 19.7%). Outcomes were referenced against a contemporaneous comparator cohort of 80 (54% OAC) consecutive patients managed with conventionally fractionated CRT within the same centre.
Three-year and median overall survival were, respectively, 56.9% and 29 months with HRT compared with 55.5% and 26 months for CRT; adjusted hazard ratio 0.79 (95% confidence interval 0.48-1.28). Grade 3 and 4 toxicity rates were low at 16.4% (n = 10) for those receiving HRT and 40.2% (n = 32) for the CRT group. In patients with OAC, CRT delivered superior overall survival (hazard ratio 0.46; 95% confidence interval 0.25-0.85) and progression-free survival (hazard ratio 0.45; 95% confidence interval 0.23-0.88) when compared with HRT.
The HRT regimen described here was safe and tolerable in patients unable to receive CRT, and delivered promising survival outcomes. The use of HRT for the treatment of oesophageal cancer, both alone and as a sequential or concurrent treatment with chemotherapy, requires further study. New precision radiotherapy technologies may provide additional scope for improving outcomes in oesophageal cancer using HRT-based approaches and should be evaluated.
放化疗（CRT）是中下段食管癌非手术治疗的首选治疗方法。对于因选择或合并症而不能接受 CRT 的患者，几乎没有证据可以指导单一模式放疗的实施。在这项研究中，我们总结了不适合 CRT 的患者接受分割剂量放疗（HRT）治疗的结果。
这是一项英国单中心回顾性分析，纳入了 2009 年 4 月至 2014 年间采用根治性 HRT 治疗的 61 例下段或中段腺癌（OAC；61%）或食管鳞状细胞癌患者。治疗方案包括 50 Gy/16 次（n=49，80.3%）或 50-52.5 Gy/20 次（n=12，19.7%）。将这些结果与同期在同一中心接受常规分割 CRT 治疗的 80 例（54%为 OAC）连续患者的对照组进行比较。
HRT 组的 3 年和中位总生存率分别为 56.9%和 29 个月，而 CRT 组为 55.5%和 26 个月；调整后的危险比为 0.79（95%置信区间为 0.48-1.28）。HRT 组的 3 级和 4 级毒性发生率为 16.4%（n=10），而 CRT 组为 40.2%（n=32）。在 OAC 患者中，与 HRT 相比，CRT 可显著提高总生存率（危险比 0.46；95%置信区间 0.25-0.85）和无进展生存率（危险比 0.45；95%置信区间 0.23-0.88）。
对于不能接受 CRT 的患者，这里描述的 HRT 方案是安全且可耐受的，并能带来有希望的生存结果。HRT 无论是单独使用，还是作为化疗的序贯或同期治疗，都需要进一步研究。新的精确放疗技术可能会为使用 HRT 方法治疗食管癌提供进一步提高疗效的机会，应该对此进行评估。
