Department of Radiotherapy, Inner Mongolia Cancer Hospital, The Affiliated People's Hospital of Inner Mongolia Medical University, Hohhot; Department of Obstetrics and Gynecology, Chinese PLA General Hospital, Beijing, China; Research Group for Reproductive Medicine and IVF-Laboratory, Department of Obstetrics and Genecology, University of Cologne, Cologne, Germany.
Bosn J Basic Med Sci. 2019 May 20;19(2):186-194. doi: 10.17305/bjbms.2019.3873.
Cervical esophageal cancer (CEC) is uncommon, accounting for less than 5% of all esophageal cancers. The management of CEC is controversial. This study investigated treatment outcomes and prognostic factors of survival in CEC patients undergoing definitive radiotherapy or concurrent chemoradiotherapy (CCRT). Ninety-one CEC patients were treated by intensity-modulated radiation therapy (IMRT) and three-dimensional conformal radiation therapy (3DCRT) between July 2007 and September 2017. The mean prescription dose was 64 Gy (range 54-70 Gy) delivered as 1.8-2.2 Gy per fraction per day, 5 days a week. Out of 91 patients, 34 received concurrent cisplatin-based chemotherapy (CT) including 18 patients who also received neoadjuvant CT. Overall survival (OS), locoregional failure-free survival (LRFFS), and progression-free survival (PFS) were estimated by the Kaplan-Meier method. Prognostic factors of survival were determined in univariate (log-rank test) and multivariate (Cox proportional hazard model) analysis. Treatment-related toxicity was also assessed. Median follow-up time for all patients was 19 months. Two-year OS, LRFFS and PFS of all patients were 58.2%, 52.5% and 48.1%, respectively. Clinical stage was an independent prognostic factor for OS (HR = 2.35, 95% CI: 1.03-5.37, p = 0.042), LRFFS (HR = 3.84, 95% CI: 1.38-10.69, p = 0.011), and PFS (HR = 2.68, 95% CI: 1.11-6.45, p = 0.028). Hoarseness was an independent prognostic factor for OS (HR = 2.10, 95% CI: 1.05-4.19, p = 0.036). CCRT was independently associated with better LRFFS (HR = 0.33, 95% CI: 0.14-0.79, p = 0.012). 3DCRT and IMRT with concurrent CT is well-tolerated and may improve local tumor control in CEC patients. Advanced clinical stage and hoarseness are adverse prognostic factors for OS, LRFFS, and PFS in CEC.
颈段食管癌（CEC）较为少见，占所有食管癌的比例不足 5%。CEC 的治疗存在争议。本研究旨在探讨接受根治性放疗或同期放化疗（CCRT）的 CEC 患者的治疗结果和生存预后因素。
2007 年 7 月至 2017 年 9 月期间，91 例 CEC 患者接受了调强放疗（IMRT）和三维适形放疗（3DCRT）治疗。中位处方剂量为 64Gy（范围 54-70Gy），1.8-2.2Gy/次，1 次/天，5 天/周。91 例患者中，34 例接受了顺铂为基础的同期化疗（CT），其中 18 例患者还接受了新辅助 CT。采用 Kaplan-Meier 法估计总生存（OS）、无局部区域失败生存（LRFFS）和无进展生存（PFS）。采用单因素（对数秩检验）和多因素（Cox 比例风险模型）分析确定生存预后因素。同时评估治疗相关毒性。所有患者的中位随访时间为 19 个月。所有患者的 2 年 OS、LRFFS 和 PFS 分别为 58.2%、52.5%和 48.1%。临床分期是 OS（HR=2.35，95%CI：1.03-5.37，p=0.042）、LRFFS（HR=3.84，95%CI：1.38-10.69，p=0.011）和 PFS（HR=2.68，95%CI：1.11-6.45，p=0.028）的独立预后因素。声音嘶哑是 OS（HR=2.10，95%CI：1.05-4.19，p=0.036）的独立预后因素。CCRT 与更好的 LRFFS 相关（HR=0.33，95%CI：0.14-0.79，p=0.012）。3DCRT 和 IMRT 联合同期 CT 具有良好的耐受性，可能提高 CEC 患者的局部肿瘤控制率。晚期临床分期和声音嘶哑是 CEC 患者 OS、LRFFS 和 PFS 的不良预后因素。
