Wu Leilei, Zhang Zhenshan, Li Shuo, Ke Linping, Yu Jinming, Meng Xue
Department of Radiation Oncology, School of Medicine, Shandong University, Jinan, People's Republic of China.
Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, People's Republic of China.
Cancer Manag Res. 2020 Oct 27;12:10573-10585. doi: 10.2147/CMAR.S276426. eCollection 2020.
Postoperative adjuvant radiation therapy (RT) and chemotherapy (aCRT) have been supposed to improve prognosis and outcomes in patients with node-positive thoracic esophageal squamous cell carcinoma (TESCC). Our aim was to analyze the impacts of interval between surgery and aCRT on prognosis, determining the optimal time interval.
We retrospectively reviewed 520 patients with TESCC between 2007 and 2015 treated with aCRT following radical esophagectomy without neoadjuvant chemotherapy and RT. These patients underwent RT (50-60 Gy) combined with 2-6 cycles chemotherapy after surgery. The time intervals were from 17 days to 145 days and divided into three groups: short interval group (≤28 days, S-Int group), medial interval group (≥29 and ≤ 56 days, M-Int group) and long interval group (≥57 days, L-Int group).
Median follow-up was 35.6 months and the 3-, 5-year survival rates and median survival were 49.5%, 36.6% and 35.9 months. The duration of postoperative interval was a predictor of survival outcomes. The median survival and 5-year survival rates in S-Int, M-Int and L-Int groups were 23.6 (32.1%), 44.2 (43.3%) and 32.0 (31.5%) months (P=0.007). The difference was statistically significant between the M-Int and S-Int or L-Int group but was not between the S-Int and L-Int group. Besides, toxic reactions including early, late and adverse events (grade ≥3) in M-Int group were significantly less than S-Int and show no significant differences with L-Int group.
The optimal time interval was from 29 days to 56 days (5-8 weeks) both in terms of survival outcomes and toxic reactions.
术后辅助放疗（RT）和化疗（aCRT）被认为可改善胸段食管鳞状细胞癌（TESCC）淋巴结阳性患者的预后和结局。我们的目的是分析手术与aCRT之间的间隔时间对预后的影响，确定最佳时间间隔。
我们回顾性分析了2007年至2015年间520例接受根治性食管切除术后接受aCRT治疗且未行新辅助化疗和放疗的TESCC患者。这些患者术后接受了50-60 Gy的放疗联合2-6周期化疗。时间间隔为17天至145天，分为三组：短间隔组（≤28天，S-Int组）、中间隔组（≥29天且≤56天，M-Int组）和长间隔组（≥57天，L-Int组）。
中位随访时间为35.6个月，3年、5年生存率和中位生存期分别为49.5%、36.6%和35.9个月。术后间隔时间是生存结局的一个预测因素（P=0.02）。S-Int组、M-Int组和L-Int组的中位生存期和5年生存率分别为23.6（32.1%）、44.2（43.3%）和32.0（31.5%）个月（P=0.007）。M-Int组与S-Int组或L-Int组之间差异有统计学意义，但S-Int组与L-Int组之间无差异。此外，M-Int组的早期、晚期及不良事件（≥3级）等毒性反应明显少于S-Int组，但与L-Int组无显著差异。
从生存结局及毒性反应方面来看，最佳时间间隔为29天至56天（5-8周）。
