根治性切除术后淋巴结复发的挽救性治疗。
Salvage treatment for lymph node recurrence after radical resection of esophageal squamous cell carcinoma.
机构信息
Department of Radiation Oncology, The Third Affiliated Hospital of Soochow University, No. 185 Juqian Street, Changzhou, 213003, China.
出版信息
Radiat Oncol. 2019 Sep 18;14(1):169. doi: 10.1186/s13014-019-1377-y.
BACKGROUND
Patients with regional lymph node recurrence after radical resection of esophageal cancer have poor therapeutic outcomes. Currently, there is no standard treatment for regional lymph node recurrence, and its prognostic risk factors are not well-understood. This study retrospectively analyzed 83 patients with postoperative regional lymph node recurrence after radical resection of esophageal squamous cell carcinoma. The aim was to evaluate the clinical efficacy and prognostic factors of salvage radiotherapy with or without chemotherapy in these patients.
METHODS
The survival and prognostic factors of 83 patients with esophageal squamous cell carcinoma with regional lymph node recurrence after radical surgery were retrospectively analyzed. All patients underwent radiotherapy, of which 74 patients received volumetric modulated arc therapy (VMAT), 9 patients received three-dimensional conformal radiation therapy (3DCRT), administered using a conventional segmentation protocol with a dose distribution range of 50.4-66.2Gy (median dose of 60Gy). In total, 41 patients received radiotherapy alone, 42 received radiotherapy combined with chemotherapy, and the concurrent chemotherapy regimen was mainly composed of either platinum or fluorouracil monotherapy, except for 4 patients who were given 5-fluorouracil plus platinum (FP) or paclitaxel plus platinum (TP).
RESULTS
The median follow-up time was 24 (range, 9-75) months. The overall survival (OS) rates at 1 year, 2 years, 3 years, and 5 years were 83.0, 57.1, 40.1, and 35.1%, respectively. The median overall survival (OS) time was 18 (range, 5-75) months. The 3-year survival rate was 47.5% in patients with radiation alone and 41.9% in patients receiving concurrent chemoradiotherapy(p = 0.570), while the response rate (CR + PR) in those two groups was 73.2 and 91.4%, respectively. By multivariate analysis of OS, age (worse in younger patients, p = 0.034) was found to be significantly associated with disease prognosis. The commonly toxicities were esophagitis, neutropenia and anemia. 18% patients experienced grade 3 toxicity and no treatment-related death occurred.
CONCLUSIONS
These results of this retrospective analysis suggest that radiotherapy with or without chemotherapy is an effective and feasible salvage treatment for lymph node recurrence after radical resection of esophageal squamous cell carcinoma.
背景
食管癌根治术后区域淋巴结复发的患者治疗效果较差。目前，对于区域淋巴结复发尚无标准的治疗方法，其预后的危险因素也不明确。本研究回顾性分析了 83 例根治性手术后食管鳞癌区域淋巴结复发患者的资料，旨在评估挽救性放化疗在这些患者中的临床疗效和预后因素。
方法
回顾性分析 83 例根治性手术后食管鳞癌区域淋巴结复发患者的生存和预后因素。所有患者均接受放疗，其中 74 例行容积旋转调强放疗（VMAT），9 例行三维适形放疗（3DCRT），采用常规分割方案，剂量分布范围为 50.4-66.2Gy（中位剂量 60Gy）。41 例患者单纯放疗，42 例患者行放化疗联合治疗，同期化疗方案主要为铂类或氟尿嘧啶单药，4 例患者给予氟尿嘧啶联合铂类（FP）或紫杉醇联合铂类（TP）。
结果
中位随访时间为 24（9-75）个月。1 年、2 年、3 年和 5 年总生存率（OS）分别为 83.0%、57.1%、40.1%和 35.1%，中位 OS 时间为 18（5-75）个月。单纯放疗和同期放化疗患者的 3 年生存率分别为 47.5%和 41.9%（p=0.570），两组的客观缓解率（CR+PR）分别为 73.2%和 91.4%。多因素分析显示，年龄（年轻患者预后较差，p=0.034）与疾病预后显著相关。常见的毒性反应为食管炎、中性粒细胞减少和贫血。18%的患者出现 3 级毒性反应，无治疗相关死亡。
结论
本回顾性分析结果表明，对于根治性手术后食管鳞癌区域淋巴结复发，放化疗是一种有效可行的挽救性治疗方法。
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