Ren X J, Wang L, Han C, Liu L L
Department of Radiation Oncology, the Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China.
Zhonghua Zhong Liu Za Zhi. 2019 Feb 23;41(2):135-139. doi: 10.3760/cma.j.issn.0253-3766.2019.02.011.
To compare the efficacy and treatment-related toxicity of high dose versus standard dose radiotherapy in concurrent chemoradiotherapy (CCRT) for patients with esophageal squamous cell carcinoma (ESCC). From 2005 to 2012, 183 pairs of patients with esophageal squamous cell carcinoma in the Fourth Hospital of Hebei Medical University were enrolled, all had undergone CCRT based on three-dimensional conformal radiotherapy (3D-CRT) or intensity-modulated radiotherapy (IMRT). A propensity score was constructed to match the cohort. The overall survival (OS), local control (LC) probability, as well as the acute and late toxicities between standard-dose and high-dose groups were compared. Patients in the high-dose group had significantly better OS and LC probability compared with those in the standard-dose group: the 3-, 5- and 10-year LC rate were 60.9%, 57.6%, 52.3% versus 50.8%, 46.4%, 30.8%, respectively (=0.032). The 3-, 5- and 10-year OS were 44.3%, 36.9% and 24.5% for high-dose group, and 31.7%, 20.6% and 14.1% for the standard-dose group, respectively(=0.002). The incidence of acute radiation esophagitis (especially in grade 2 and 3) was 63.9% in high-dose group, which was significantly higher than that in the standard-dose group (59.6%). Severe (≥ grade 3) late-onset esophagitis was observed in neither group. The grade 4 acute esophagitis was rare. There was no significant difference in the incidence of radiation pneumonitis, gastrointestinal reactions or hematological toxicities between the two groups. Six patients in high-dose group and two patients in standard-dose group experienced ≥ grade 4 leukocytopenia, while no one experienced > grade 3 thrombocytopenia and anemia in both group. 60 Gy was the preferred dosage of CCRT in patients with ESCC. Compared with standard-dose, the high-dose CCRT yielded slightly increased mild to moderate acute radiation esophagitis, while life-threatening toxicities were not increased.
比较高剂量与标准剂量放疗在食管鳞状细胞癌（ESCC）患者同步放化疗（CCRT）中的疗效及治疗相关毒性。2005年至2012年，河北医科大学第四医院纳入了183对食管鳞状细胞癌患者，所有患者均接受了基于三维适形放疗（3D-CRT）或调强放疗（IMRT）的CCRT。构建倾向评分以匹配队列。比较了标准剂量组和高剂量组的总生存期（OS）、局部控制（LC）概率以及急性和晚期毒性。高剂量组患者的OS和LC概率明显优于标准剂量组：3年、5年和10年LC率分别为60.9%、57.6%、52.3%，而标准剂量组分别为50.8%、46.4%、30.8%（P=0.032）。高剂量组的3年、5年和10年OS分别为44.3%、36.9%和24.5%，标准剂量组分别为31.7%、20.6%和14.1%（P=0.002）。高剂量组急性放射性食管炎（尤其是2级和3级）的发生率为63.9%，明显高于标准剂量组（59.6%）。两组均未观察到严重（≥3级）迟发性食管炎。4级急性食管炎罕见。两组放射性肺炎、胃肠道反应或血液学毒性的发生率无显著差异。高剂量组有6例患者、标准剂量组有2例患者发生≥4级白细胞减少，两组均无>3级血小板减少和贫血发生。60 Gy是ESCC患者CCRT的首选剂量。与标准剂量相比，高剂量CCRT导致轻度至中度急性放射性食管炎略有增加，但未增加危及生命的毒性。
