T1bN0M0 期食管癌行含野放疗与选择性淋巴结照射联合同期化疗的比较。
Comparison of involved field radiotherapy and elective nodal irradiation in combination with concurrent chemotherapy for T1bN0M0 esophageal cancer.
机构信息
Gastrointestinal Medical Oncology Division, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan.
Course of Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, Tokyo, Japan.
出版信息
Int J Clin Oncol. 2020 Jun;25(6):1098-1104. doi: 10.1007/s10147-020-01652-7. Epub 2020 Mar 18.
BACKGROUND
The optimal radiation field of chemoradiation therapy (CRT) for stage I esophageal squamous cell carcinoma (ESCC) is unknown. This retrospective study compared efficacy and safety of two CRT modalities, involved field irradiation (IFI) and elective nodal irradiation (ENI), when treating patients with clinical stage I (T1bN0M0) ESCC.
METHODS
Patients had received 60 Gy CRT concurrently with 5-FU and cisplatin between January 2000 and December 2012. The clinical target volume of IFI was limited to the primary tumor plus a 2-cm craniocaudal margin; that of ENI covered the primary tumor plus the field of regional lymph nodes.
RESULTS
One hundred and ninety-five patients were selected (IFI group, 78; ENI group, 117). The 5-year overall, cause-specific and progression-free survival rates were 90.5%, 91.6% and 77.6% in the IFI group, and 72.5%, 88.3%, 57.9% in the ENI group, respectively. Of recurrent patients (n = 16 in the IF and n = 33 in the ENI groups) after achieving complete remission, 12 (75%) in the IFI group received definitive salvage therapy, 11 (33%) patients did in the ENI group. More patients died of diseases other than esophageal cancer in the ENI group (n = 29, 25%) than in the IFI group (n = 3, 3.8%). Multivariate analysis identified ENI (HR 3.63 [1.78-7.38], p < 0.001), age ≥ 70 (HR 2.65 [1.53-4.58], p < 0.001) and PS = 1 (HR 2.36 [1.33-4.18], p = 0.003) as poor prognostic factors for OS.
CONCLUSIONS
IF irradiation would be better than ENI for the patients with stage I ESCC who received definitive chemoradiotherapy.
背景
对于 I 期食管鳞癌（ESCC）患者，化放疗的最佳照射野范围尚不清楚。本回顾性研究比较了累及野照射（IFI）和选择性淋巴结照射（ENI）两种 CRT 模式治疗临床 I 期（T1bN0M0）ESCC 患者的疗效和安全性。
方法
患者于 2000 年 1 月至 2012 年 12 月期间接受 60Gy CRT 同步顺铂和氟尿嘧啶化疗。IFI 的临床靶区限于原发肿瘤加 2cm 的头尾野；ENI 覆盖原发肿瘤加区域淋巴结区。
结果
共纳入 195 例患者（IFI 组 78 例，ENI 组 117 例）。IFI 组 5 年总生存率、无疾病特异生存率和无进展生存率分别为 90.5%、91.6%和 77.6%，ENI 组分别为 72.5%、88.3%和 57.9%。完全缓解后复发的患者（IFI 组 16 例，ENI 组 33 例），IFI 组 12 例（75%）接受了根治性挽救治疗，ENI 组 11 例（33%）。ENI 组死于非食管癌（n=29，25%）的患者多于 IFI 组（n=3，3.8%）。多因素分析显示，ENI（HR 3.63[1.78-7.38]，p<0.001）、年龄≥70 岁（HR 2.65[1.53-4.58]，p<0.001）和 PS=1（HR 2.36[1.33-4.18]，p=0.003）是 OS 的不良预后因素。
结论
对于接受根治性化放疗的 I 期 ESCC 患者，IFI 照射可能优于 ENI。
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