Luo Hongtao, Wei Shihong, Wang Xiaohu, Liu Ruifeng, Zhang Qiuning, Yang Zhen, Li Zheng, Wei Xiyi, Qi Yuexiao, Xu Lijun
The First Clinical Medical College of Lanzhou University, Lanzhou 730000, China.
Gansu Provincial Cancer Hospital, Lanzhou 730050, China.
J Cancer. 2020 Mar 4;11(10):3020-3026. doi: 10.7150/jca.41012. eCollection 2020.
: The accelerated reproliferation of esophageal squamous cell carcinoma (ESCC) after radiation contributes to conventional fraction radiotherapy (CFRT) failure. Late course accelerated hyperfractionated radiotherapy (LCAHFRT) can improve the long-term survival of esophageal cancer patients in China but is associated with a high rate of side effects due to the large exposure field of two-dimensional treatment and drug toxicity. Intensity-modulated radiotherapy (IMRT) can increase the tumor dose while decreasing the normal tissue dose. Therefore, we compared the outcomes and side effects of LCAHFIMRT plus concurrent chemotherapy (CT) and CFIMRT plus CT for ESCC. : Between 2013 and 2016, 114 eligible patients with ESCC were recruited and randomly assigned to receive LCAHFIMRT+CT (58 patients) or CFIMRT+CT (56 patients) by a linear accelerator (6-MV X-ray) under image guidance. Two cycles of CT with cisplatin and docetaxel were also administered. : The complete response (CR) rates were 79.3% and 61.8% in the LCAHFIMRT+CT and CFIMRT+CT groups, respectively (P=0.041). The median duration of local control times was 31.0±1.9 months for the LCAHFIMRT+CT group and 24.0±3.3 months for the CFIMRT+CT groups,and the 1-, 2-, and 3-year local control rates were 86.2%, 63.8%, and 41.4% and 85.7%, 51.8%, and 32.1% for the LCAHFIMRT+CT and CFIMRT+CT groups (P=0.240), respectively. The median survival times were 34.0±1.1 months for the LCAHFIMRT+CT group and 28.0.0±3.7 months for the CFIMRT groups,and the 1-, 2-, and 3-year survival rates were 87.9%, 74.1%, and 44.8% and 87.5%, 60.7%, and 39.3% for the LCAHFIMRT+CT and CFIMRT+CT groups, respectively (P=0.405). The incidence of side effects was not significantly different between the two groups. Local recurrence and uncontrolled disease resulted in more deaths in the CFIMRT+CT group than in the LCAHFIMRT+CT group (58.9% vs. 39.7%) (P=0.040). : For ESCC patients, LCAHFRT delivered by image-guided intensity-modulated techniques Plus Concurrent Chemotherapy with cisplatin and docetaxel keeps safety and high CR rate, as well as local control and long-term survival rates.
放射治疗后食管鳞状细胞癌（ESCC）的加速再增殖导致传统分割放疗（CFRT）失败。后程加速超分割放疗（LCAHFRT）可提高中国食管癌患者的长期生存率，但由于二维治疗照射野大及药物毒性，其副作用发生率较高。调强放疗（IMRT）可增加肿瘤剂量，同时降低正常组织剂量。因此，我们比较了LCAHFIMRT联合同步化疗（CT）与CFIMRT联合CT治疗ESCC的疗效和副作用。2013年至2016年，招募了114例符合条件的ESCC患者，通过直线加速器（6-MV X线）在图像引导下将其随机分为LCAHFIMRT+CT组（58例）或CFIMRT+CT组（56例）。同时给予顺铂和多西他赛两个周期的CT治疗。LCAHFIMRT+CT组和CFIMRT+CT组的完全缓解（CR）率分别为79.3%和61.8%（P=0.041）。LCAHFIMRT+CT组局部控制时间的中位数为31.0±1.9个月，CFIMRT+CT组为24.0±3.3个月，LCAHFIMRT+CT组和CFIMRT+CT组的1年、2年和3年局部控制率分别为86.2%、63.8%、41.4%和85.7%、51.8%、32.1%（P=0.240）。LCAHFIMRT+CT组中位生存时间为34.0±1.1个月，CFIMRT组为28.0±3.7个月，LCAHFIMRT+CT组和CFIMRT+CT组的1年、2年和3年生存率分别为87.9%、74.1%、44.8%和87.5%、60.7%、39.3%（P=0.405）。两组副作用发生率无显著差异。CFIMRT+CT组因局部复发和疾病未控导致的死亡人数多于LCAHFIMRT+CT组（58.9%对39.7%）（P=0.040）。对于ESCC患者，图像引导下的调强技术进行LCAHFRT联合顺铂和多西他赛同步化疗可保持安全性和高CR率以及局部控制率和长期生存率。
