同步整合剂量降低在局部晚期食管鳞状细胞癌患者调强放疗中对临床靶区的疗效和安全性
The efficacy and safety of simultaneous integrated dose reduction in clinical target volume with intensity-modulated radiotherapy for patients with locally advanced esophageal squamous cell carcinoma.
作者信息
Zhao Jingjing, Lei Tongda, Zhang Tian, Chen Xi, Dong Jie, Guan Yong, Wang Jing, Wei Hui, Er Puchun, Han Dong, Wei Xiaoying, Guo Zhoubo, Du Qingwu, Wang Jun, Liu Ningbo, Song Yongchun, Yuan Zhiyong, Zhao Lujun, Zhang Wencheng, Pang Qingsong, Wang Ping
机构信息
Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin, China.
Department of Nutritional Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin, China.
出版信息
Ann Transl Med. 2020 Sep;8(18):1160. doi: 10.21037/atm-20-4366.
BACKGROUND
Compelling research to explore the effectiveness of simultaneous integrated dose reduction in clinical target volume (CTV) with intensity-modulated radiotherapy (SIR-IMRT) for locally advanced esophageal squamous cell carcinoma (ESCC) are limited. This study aimed to compare the clinical efficacy and treatment-related toxicity between SIR-IMRT and conventional IMRT (C-IMRT) in the treatment of ESCC.
METHODS
From March 2010 to September 2016, the clinical data of 257 patients with ESCC who received definitive IMRT in the Tianjin Medical University Cancer Institute and Hospital were collected and retrospectively analyzed. Among these patients, 137 patients received C-IMRT with a prescribed dose of 60 Gy in 30 fractions for planning target volume (PTV), while 120 patients received SIR-IMRT with a prescribed dose of 60 Gy in 30 fractions for the planning gross tumor volume (PGTV) and a prescribed dose of 54 Gy in 30 fractions for PTV. All of the patients received definitive IMRT with elective nodal irradiation. Locoregional control, survival, treatment toxicity and dose to organs at risk (OAR) were compared between the groups.
RESULTS
Patients who received SIR-IMRT showed a similar locoregional failure rate compared to the C-IMRT group (27.5% versus 29.9%, P=0.668). The 1-, 2- and 3-year overall survival (OS) rates were 71.5%, 44.3%, 44.3% 77.9%, 52.1%, 32.9% in the C-IMRT and SIR-IMRT groups, respectively (P=0.825). No significant differences were observed in PFS and LRRFS between the two groups (P=0.880 and P=0.216, respectively). The dose of lung V30 and the maximum dose of spinal cord in the C-IMRT group were significantly higher than those in the SIR-IMRT group (P=0.013, P=0.047). The incidence of acute radiation esophagitis was significantly lower in the SIR-IMRT group (P=0.046), although no statistical difference was observed in the incidence of acute severe adverse events between the two groups.
CONCLUSIONS
SIR-IMRT offers an effective and safe option for patients with unresectable ESCC who receive definitive RT. Further prospective and larger sample size studies are warranted to confirm our results.
背景
关于探索同步整合剂量降低的调强放疗（SIR-IMRT）用于局部晚期食管鳞状细胞癌（ESCC）临床靶区（CTV）有效性的有力研究有限。本研究旨在比较SIR-IMRT与传统调强放疗（C-IMRT）治疗ESCC的临床疗效和治疗相关毒性。
方法
收集2010年3月至2016年9月在天津医科大学肿瘤医院接受根治性调强放疗的257例ESCC患者的临床资料并进行回顾性分析。其中，137例患者接受C-IMRT，计划靶体积（PTV）的处方剂量为60 Gy，分30次照射；120例患者接受SIR-IMRT，计划大体肿瘤体积（PGTV）的处方剂量为60 Gy，分30次照射，PTV的处方剂量为54 Gy，分30次照射。所有患者均接受根治性调强放疗及选择性淋巴结照射。比较两组的局部区域控制、生存、治疗毒性及危及器官（OAR）的剂量。
结果
接受SIR-IMRT的患者与C-IMRT组相比，局部区域失败率相似（27.5%对29.9%，P = 0.668）。C-IMRT组和SIR-IMRT组的1年、2年和3年总生存率（OS）分别为71.5%、44.3%、44.3%和77.9%、52.1%、32.9%（P = 0.825）。两组间无进展生存期（PFS）和局部区域复发无进展生存期（LRRFS）无显著差异（分别为P = 0.880和P = 0.216）。C-IMRT组的肺V30剂量和脊髓最大剂量显著高于SIR-IMRT组（P = 0.013，P = 0.047）。SIR-IMRT组急性放射性食管炎的发生率显著较低（P = 0.046），尽管两组间急性严重不良事件的发生率无统计学差异。
结论
SIR-IMRT为接受根治性放疗的不可切除ESCC患者提供了一种有效且安全的选择。需要进一步进行前瞻性、更大样本量的研究来证实我们的结果。
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