几种用于缓解食管癌症状的外照射放疗方案的有效性
Effectiveness of several external beam radiotherapy schedules for palliation of esophageal cancer.
作者信息
Walterbos Natasja R, Fiocco Marta, Neelis Karen J, van der Linden Yvette M, Langers Alexandra M J, Slingerland Marije, de Steur Wobbe O, Peters Femke P, Lips Irene M
机构信息
Department of Radiation Oncology, Leiden University Medical Center, Postzone K0-P, P.O. Box 9600, 2300 RC Leiden, The Netherlands.
Department of Biomedical Data Science, Section Medical Statistics, Leiden University Medical Center, Postzone S5-P, P.O. Box 9600, 2300 RC Leiden, The Netherlands.
出版信息
Clin Transl Radiat Oncol. 2019 Apr 24;17:24-31. doi: 10.1016/j.ctro.2019.04.017. eCollection 2019 Jul.
BACKGROUND AND PURPOSE
Although external beam radiotherapy (EBRT) is frequently used for palliative treatment of patients with incurable esophageal cancer, the optimal schedule for symptom control is unknown. This retrospective study evaluated three EBRT schedules for symptom control and investigated possible prognostic factors associated with second intervention and overall survival (OS).
MATERIAL AND METHODS
Patients with esophageal cancer treated with EBRT with palliative intent between January 2009 and December 2015 were evaluated. Univariate and multivariate Cox regression models estimated the effect of treatment schedule (20 Gy in 5 fractions, 30 Gy in 10 fractions or 39 Gy in 13 fractions) on OS. To study the effect of prognostic factors on time to second intervention (repeat EBRT, intraluminal brachytherapy or stent placement) a competing risk model with death as competing event was used.
RESULTS
205 patients received 20 Gy (31%), 30 Gy (38%) or 39 Gy (32%). Improvement of symptoms was observed in 72% with no differences between schedules. Median OS after 20 Gy, 30 Gy and 39 Gy was 4.6 months (95%CI 2.6-6.6), 5.2 months (95%CI 3.7-6.7) and 9.7 months (95%CI 6.9-12.5), respectively. Poor performance status (HR 2.25 (95%CI 1.53-3.29)), recurrent esophageal cancer (HR 1.69 (95%CI 1.15-2.47)) and distant metastasis (HR 1.73 (95%CI 1.27-2.35)) were significantly related to worse OS. Treatment with 30 Gy and 39 Gy was related to longer time to second intervention compared to 20 Gy (adjusted cause specific HR 0.50 (95%CI 0.25-0.99) and 0.27 (95%CI 0.13-0.56), respectively).
CONCLUSIONS
Palliative EBRT provides good symptom control in patients with symptomatic esophageal cancer. A higher dose schedule was related to a longer time to second intervention. Hence, selection based on life expectancy is vital to prevent unnecessary long treatment schedules in patients with expected short survival, and limit the chance of second intervention when life expectancy is longer.
背景与目的
尽管外照射放疗（EBRT）常用于无法治愈的食管癌患者的姑息治疗，但症状控制的最佳方案尚不清楚。这项回顾性研究评估了三种EBRT方案对症状的控制情况，并调查了与二次干预及总生存期（OS）相关的可能预后因素。
材料与方法
对2009年1月至2015年12月间接受姑息性EBRT治疗的食管癌患者进行评估。单因素和多因素Cox回归模型估计治疗方案（5次分割照射20 Gy、10次分割照射30 Gy或13次分割照射39 Gy）对总生存期的影响。为研究预后因素对二次干预时间（重复EBRT、腔内近距离放疗或支架置入）的影响，使用了以死亡作为竞争事件的竞争风险模型。
结果
205例患者接受了20 Gy（31%）、30 Gy（38%）或39 Gy（32%）的照射。72%的患者症状得到改善，各方案之间无差异。20 Gy、30 Gy和39 Gy照射后的中位总生存期分别为4.6个月（95%CI 2.6 - 6.6）、5.2个月（95%CI 3.7 - 6.7）和9.7个月（95%CI 6.9 - 12.5）。体能状态差（HR 2.25（95%CI 1.53 - 3.29））、复发性食管癌（HR 1.69（95%CI 1.15 - 2.47））和远处转移（HR 1.73（95%CI 1.27 - 2.35））与较差的总生存期显著相关。与20 Gy相比，30 Gy和39 Gy的治疗与二次干预时间更长有关（调整后的特定病因HR分别为0.50（95%CI 0.25 - 0.99）和0.27（95%CI 0.13 - 0.56））。
结论
姑息性EBRT可为有症状的食管癌患者提供良好的症状控制。较高剂量方案与二次干预时间更长有关。因此，根据预期寿命进行选择对于防止预期生存期短的患者接受不必要的长疗程治疗至关重要，并在预期寿命较长时限制二次干预的机会。
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