Modesto A, Dalmasso C, Lusque A, Vieillevigne L, Izar F, Moyal E, Carrère N, Guimbaud R, Rives M
Radiation Oncology Department, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse, 1, avenue Irène Joliot-Curie, 31059 Toulouse Cedex 9, France.
Radiation Oncology Department, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse, 1, avenue Irène Joliot-Curie, 31059 Toulouse Cedex 9, France.
Cancer Radiother. 2020 Apr;24(2):88-92. doi: 10.1016/j.canrad.2020.01.006. Epub 2020 Mar 7.
The optimal dose in esophageal cancer patients treated with definitive chemoradiation (CRT) remains debated. We herein report on the dosimetric results, treatment-related toxicities and long-term outcomes of escalated dose up to 60Gy delivered with intensity-modulated radiotherapy (IMRT).
All consecutive patients that received a definitive CRT>50Gy for an unresectable esophageal carcinoma between 2010 and 2015 were retrospectively evaluated for this study. Methodology included data base search, delayed toxicity grading, statistical testing including frequency analysis and survival analysis.
A total of 51 patients were irradiated for a squamous cell carcinoma (86.3%) or an adenocarcinoma (13.7%). The median age at diagnosis was 62 years. Seven patients were simultaneously irradiated for another synchronous primary tumor. Forty-six patients (90.2%) received concurrent platin-based chemotherapy. The median prescribed doses were 60Gy (54-66) and 48Gy (44.8-56) delivered in 30 (27-35) fractions to the high and the low risks PTV respectively. The mean dose delivered to the lungs was 11.4Gy (IC 95%: 4.8-19.8), the median volumes receiving up to 20Gy (V20) and 30Gy (V30) were 13.5% (3.0-46.0) and 4.6% (0.7-19.8) respectively. The mean dose delivered to the heart was 13.9Gy (IC 95%:0.3-31.3) with a median V40 of 3.3% (0.0-25.0). One treatment-related death occurred within days after RT completion (neutropenic aplasia). After a median follow-up of 2.7 years (95% CI: 1.9-4.3), the 2-year overall survival, disease free survival and loco-regional control rates were 53.6%, 42.0% and 72.8% respectively. Delayed treatment related-toxicities ≤grade 3 occurred among 25 patients (62.5%) mostly esophageal stricture (79.2%).
We demonstrated in this study that dose escalation using IMRT in combination with platin-based chemotherapy as a definitive treatment for esophageal carcinoma is safe and results in higher loco-regional and control survival when compared to previously reported data.
对于接受根治性放化疗（CRT）的食管癌患者，最佳剂量仍存在争议。我们在此报告采用调强放射治疗（IMRT）给予高达60Gy递增剂量的剂量学结果、治疗相关毒性及长期疗效。
对2010年至2015年间所有因不可切除食管癌接受根治性CRT且剂量>50Gy的连续患者进行回顾性评估。方法包括数据库检索、延迟毒性分级、包括频率分析和生存分析在内的统计检验。
共51例患者接受了鳞状细胞癌（86.3%）或腺癌（13.7%）的放疗。诊断时的中位年龄为62岁。7例患者同时接受了另一同步原发肿瘤的照射。46例患者（90.2%）接受了基于铂类的同步化疗。分别以30次（27 - 35次）分割给予高危和低危计划靶体积（PTV）的中位处方剂量为60Gy（54 - 66）和48Gy（44.8 - 56）。给予肺的平均剂量为11.4Gy（95%可信区间：4.8 - 19.8），接受高达20Gy（V20）和30Gy（V30）的中位体积分别为13.5%（3.0 - 46.0）和4.6%（0.7 - 19.8）。给予心脏的平均剂量为13.9Gy（95%可信区间：0.3 - 31.3），中位V40为3.3%（0.0 - 25.0）。放疗完成后数天内发生1例治疗相关死亡（中性粒细胞缺乏性再生障碍）。中位随访2.7年（95%可信区间：1.9 - 4.3）后，2年总生存率、无病生存率和局部区域控制率分别为53.6%、42.0%和72.8%。25例患者（62.5%）发生≤3级延迟治疗相关毒性，主要为食管狭窄（79.2%）。
我们在本研究中证明，采用IMRT联合基于铂类的化疗进行剂量递增作为食管癌的根治性治疗是安全的，与既往报道的数据相比，可提高局部区域控制率和生存率。
