Bhangoo Ronik S, DeWees Todd A, Yu Nathan Y, Ding Julia X, Liu Chenbin, Golafshar Michael A, Rule William G, Vora Sujay A, Ross Helen J, Ahn Daniel H, Beamer Staci E, Jaroszewski Dawn E, Hallemeier Christopher L, Liu Wei, Ashman Jonathan B, Sio Terence T
Department of Radiation Oncology, Mayo Clinic Hospital, Phoenix, Arizona.
Biostatistics, Mayo Clinic, Scottsdale, Arizona.
Adv Radiat Oncol. 2020 May 19;5(5):871-879. doi: 10.1016/j.adro.2020.04.026. eCollection 2020 Sep-Oct.
Intensity modulated proton beam radiation therapy (IMPT) has a clinically significant dosimetric advantage over intensity modulated photon radiation therapy (IMRT) for the treatment of patients with esophageal cancer, particularly for sparing the heart and lungs. We compared acute radiation therapy-related toxicities and short-term clinical outcomes of patients with esophageal cancer who received treatment with IMPT or IMRT.
We retrospectively reviewed the electronic health records of consecutive adult patients with esophageal cancer who underwent concurrent chemoradiotherapy with IMPT or IMRT in the definitive or neoadjuvant setting from January 1, 2014, through June 30, 2018, with additional follow-up data collected through January 31, 2019. Treatment-related toxicities were evaluated per the Common Terminology Criteria for Adverse Events, version 4. Survival outcomes were estimated with the Kaplan-Meier method.
A total of 64 patients (32 per group) were included (median follow-up time: 10 months for IMPT patients vs 14 months for IMRT patients). The most common radiation therapy regimen was 45 Gy in 25 fractions, and 80% of patients received a simultaneous integrated boost to a median cumulative dose of 50 Gy. Similar numbers of IMPT patients (n = 15; 47%) and IMRT patients (n = 18; 56%) underwent surgery ( = .07), with no difference in pathologic complete response rates (IMPT: n = 5; 33% vs IMRT: n = 7; 39%; = .14). At 1 year, the clinical outcomes also were similar for IMPT and IMRT patients, respectively. Local control was 92% versus 84% ( = .87), locoregional control 92% versus 80% ( = .76), distant metastasis-free survival 87% versus 65% ( = .08), progression-free survival 71% versus 45% ( = .15), and overall survival 74% versus 71% ( = .62). The rate of acute treatment-related grade 3 toxicity was similar between the groups ( = .71).
In our early experience, IMPT is a safe and effective treatment when administered as part of definitive or trimodality therapy. Longer follow-up is required to evaluate the effectiveness of IMPT.
在治疗食管癌患者时，调强质子束放射治疗（IMPT）相较于调强光子放射治疗（IMRT）具有临床上显著的剂量学优势，尤其是在保护心脏和肺部方面。我们比较了接受IMPT或IMRT治疗的食管癌患者的急性放射治疗相关毒性和短期临床结局。
我们回顾性分析了2014年1月1日至2018年6月30日期间在根治性或新辅助治疗中接受IMPT或IMRT同步放化疗的连续性成年食管癌患者的电子健康记录，并收集了截至2019年1月31日的额外随访数据。根据不良事件通用术语标准第4版评估治疗相关毒性。采用Kaplan-Meier方法估计生存结局。
共纳入64例患者（每组32例）（IMPT组患者的中位随访时间为10个月，IMRT组患者为14个月）。最常见的放射治疗方案是25次分割给予45 Gy，80%的患者同时接受了中位累积剂量为50 Gy的同步推量照射。接受手术的IMPT组患者（n = 15；47%）和IMRT组患者（n = 18；56%）数量相似（P = 0.07），病理完全缓解率无差异（IMPT组：n = 5；33% vs IMRT组：n = 7；39%；P = 0.14）。1年时，IMPT组和IMRT组患者的临床结局也分别相似。局部控制率分别为92%和84%（P = 0.87），区域控制率分别为92%和80%（P = 0.76），无远处转移生存率分别为87%和65%（P = 0.08），无进展生存率分别为71%和45%（P = 0.15），总生存率分别为74%和71%（P = 0.62）。两组急性治疗相关3级毒性发生率相似（P = 0.71）。
根据我们的早期经验，IMPT作为根治性或三联疗法一部分进行应用时是一种安全有效的治疗方法。需要更长时间的随访来评估IMPT的有效性。
