Sichuan Cancer Hospital and Institute, Chengdu, China.
School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
Cancer Med. 2019 Jul;8(8):3710-3718. doi: 10.1002/cam4.2250. Epub 2019 May 22.
We compared the efficacy, safety, and costs of hypofractionated radiotherapy (HFRT) and conventional fractionated radiotherapy (CFRT) for the neoadjuvant treatment of esophageal cancer.
Overall, 110 patients with esophageal cancer treated with neoadjuvant chemoradiotherapy from October 2002 to July 2017 were retrospectively included and divided into a HFRT group (42 patients received 30 Gray [Gy]/10 fractions for 2 weeks) and a CFRT group [68 patients received 40 Gy/20 fractions for 4 weeks]. Concurrent chemotherapy comprised cisplatin combined with either 5-FU or taxane. Surgery was performed 3-8 weeks after radiotherapy. We compared the outcomes, adverse events, and costs between the two groups.
Pathological downstaging was achieved in 78.6% of the HFRT group and 83.8% of the CFRT group (P = 0.612). Compared with the CFRT group, the HFRT group had similar pathological complete response (pCR) (33.3% vs 35.3%; P = 0.834), median overall survival (OS) (40.8 months vs 44.9 months; P = 0.772) and progression free survival (32.7 months vs 35.4 months; P = 0.785). The perioperative complication rates were also similar between the groups, but the treatment time and costs were significantly reduced in the HFRT group (P < 0.05). Finally, multivariate analysis identified cN0 stage, pathological downstaging and pCR as independent predictors of better OS.
Preoperative HFRT is effective and safe for esophageal cancer. Moreover, it is similar to CFRT in terms of overall survival and toxicity and is cost effective and less time consuming.
我们比较了适形分割放疗（CFRT）和Hypofractionated 放疗（HFRT）在新辅助治疗食管癌中的疗效、安全性和成本。
回顾性纳入 2002 年 10 月至 2017 年 7 月接受新辅助放化疗的 110 例食管癌患者，分为 HFRT 组（42 例，2 周内接受 30 Gy/10 次分割）和 CFRT 组（68 例，4 周内接受 40 Gy/20 次分割）。同期化疗采用顺铂联合氟尿嘧啶或紫杉类药物。放疗后 3-8 周行手术治疗。比较两组患者的结局、不良反应和成本。
HFRT 组和 CFRT 组的病理降期率分别为 78.6%和 83.8%（P=0.612）。与 CFRT 组相比，HFRT 组的病理完全缓解率（pCR）相似（33.3%比 35.3%；P=0.834），中位总生存期（OS）（40.8 个月比 44.9 个月；P=0.772）和无进展生存期（32.7 个月比 35.4 个月；P=0.785）相似。两组围手术期并发症发生率也相似，但 HFRT 组的治疗时间和费用明显降低（P<0.05）。多因素分析发现 cN0 期、病理降期和 pCR 是 OS 更好的独立预测因素。
术前 HFRT 治疗食管癌有效且安全，与 CFRT 相比，在总生存和毒性方面相似，具有成本效益，治疗时间更短。
