Department of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Department of Gastrosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Cancer Rep (Hoboken). 2021 Jun;4(3):e1332. doi: 10.1002/cnr2.1332. Epub 2020 Dec 28.
Patterns of failure following definitive CRT (dCRT) are different as compared to neoadjuvant chemoradiotherapy (NACRT) with increased locoregional failures documented with dCRT.
To document failure patterns in patients with esophageal carcinoma treated with neoadjuvant and definitive intent radiation strategies.
Subjects were 123 patients treated with two chemoradiotherapy strategies. Group 1 (n = 99) underwent dose escalated definitive chemoradiotherapy (dCRT), Group 2 (n = 24) received neoadjuvant chemoradiotherapy (NACRT) followed by surgery. Cumulative incidence of locoregional failure (LRF), local failure (LF), regional lymph node failure (RLNF), and distant metastasis (DM) were computed; differences between the groups was evaluated using log rank test. Univariable and multivariable predictors of failure were identified using Cox regression analysis.
Cumulative LRF: 64% in Group 1 vs 35% in Group 2 (P = .050). Cumulative LF: 59% in Group 1 vs 12% in Group 2 (P = .000). Cumulative RLNF: 30% in Group 1 vs 24% in Group 2 (P = .592). Most common RLNF: mediastinum for both groups (6% vs 12.5%, respectively). Distant metastasis: 40.4% Group 1 vs 17% Group 2 (P = .129), predominantly lung (Group 1, 5%), and nonregional nodes (Group 2, 8.3%). Univariate analysis identified age ≤50, absence of concurrent chemotherapy, dose ≤50 Gy, and incomplete radiotherapy to predict higher odds of LRF and DM for Group 1; absence of comorbidities predicted for lower odds of LRF for Group 2. Age ≤50 predicted for higher odds of RNLR for Group 1, while absence of comorbidities predicted for lower odds of RNLR in Group 2. Multivariate analysis identified age ≤50, incomplete radiotherapy, and absence of concurrent chemotherapy to predict higher odds of LRF for Group 1. Age ≤50, absence of concurrent chemotherapy predicted higher odds of DM for Group 1. Absence of comorbidity predicted lower odds of LRF in Group 2.
LRF is common in both groups, with LF being predominant in dCRT as opposed to RNLF in NACRT. Age ≤50, absence of concurrent chemotherapy is a predictor of LRF and DM in dCRT.
与新辅助放化疗（NACRT）相比，根治性放化疗（dCRT）后的失败模式不同，dCRT 中记录到更多的局部区域失败。
记录采用新辅助和根治性放疗策略治疗食管癌患者的失败模式。
对 123 例接受两种放化疗策略治疗的患者进行了研究。第 1 组（n=99）接受了递增剂量的根治性放化疗（dCRT），第 2 组（n=24）接受了新辅助放化疗（NACRT）加手术。计算局部区域失败（LRF）、局部失败（LF）、区域淋巴结失败（RLNF）和远处转移（DM）的累积发生率；采用对数秩检验评估两组之间的差异。采用 Cox 回归分析确定失败的单变量和多变量预测因素。
LRF 的累积发生率：第 1 组为 64%，第 2 组为 35%（P=0.050）。LF 的累积发生率：第 1 组为 59%，第 2 组为 12%（P=0.000）。RLNF 的累积发生率：第 1 组为 30%，第 2 组为 24%（P=0.592）。最常见的 RLNF：两组均为纵隔（分别为 6%和 12.5%）。远处转移：第 1 组为 40.4%，第 2 组为 17%（P=0.129），主要是肺（第 1 组 5%）和非区域淋巴结（第 2 组 8.3%）。单变量分析确定年龄≤50 岁、无同期化疗、剂量≤50Gy 和不完全放疗是第 1 组 LRF 和 DM 更高可能性的预测因素；无合并症预测第 2 组 LRF 的可能性较低。年龄≤50 岁预测第 1 组 RNLR 的可能性更高，而无合并症预测第 2 组 RNLR 的可能性更低。多变量分析确定年龄≤50 岁、不完全放疗和无同期化疗是第 1 组 LRF 更高可能性的预测因素。年龄≤50 岁、无同期化疗预测第 1 组 DM 的可能性更高。无合并症预测第 2 组 LRF 的可能性较低。
两组的 LRF 均很常见，dCRT 中 LF 为主，而 NACRT 中 RLNF 为主。年龄≤50 岁、无同期化疗是 dCRT 中 LRF 和 DM 的预测因素。无合并症是第 2 组 LRF 的预测因素。
