Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Cancer Med. 2021 Feb;10(4):1275-1288. doi: 10.1002/cam4.3724. Epub 2021 Jan 20.
To report outcomes and toxicity in patients who received definitive concurrent chemoradiation (DCCRT) for non-operable esophageal cancer (EC) in the modern era, and to identify markers of overall and disease-free survival (OS/DFS).
We conducted a retrospective cohort study of patients with unresectable EC who received DCCRT at our institution between 1/2008 and 1/2019. Descriptive statistics were used to report disease-control outcomes and CTCAE v4.0-5.0 toxicities. Univariable and multivariable Cox regression, and stepwise regression were used to identify associations with survival.
At a median follow-up of 19.5 months, 130 patients with adenocarcinoma (AC) (62%) or squamous cell carcinoma (SCC) (38%) were evaluable (Stage II-III: 92%). Patients received carboplatin/paclitaxel (75%) or fluorouracil-based (25%) concurrent chemotherapy. Median total RT dose was 50.4 Gy (range, 44.7-71.4 Gy) delivered in 28 fractions (24-35). Locoregional and distant recurrence occurred in 30% and 35% of AC, and 24% and 33% of SCC, respectively. Median OS and DFS were 22.9 and 10.7 months in AC, and 25.7 and 20.2 months in SCC, respectively. On stepwise regression, tumor stage, feeding tube during DCCRT, and change in primary tumor PET/CT SUVmax were significantly associated with OS and DFS. Most severe toxicities were acute grade 4 hematologic cytopenia (6%) and radiation dermatitis (1%). Most common acute grade 3 toxicities were hematologic cytopenia (35%), dysphagia (23%), and anorexia (19%).
Treatment of non-operable EC with DCCRT has acceptable toxicity and can provide multi-year disease control for some patients, even in AC. Continued follow-up and investigation in large studies would be useful.
报告在现代接受不可切除食管癌（EC）同期放化疗（DCCRT）的患者的结局和毒性，并确定总生存（OS）和无病生存（DFS）的标志物。
我们对在我院接受 DCCRT 的不可切除 EC 患者进行了回顾性队列研究，时间为 2008 年 1 月至 2019 年 1 月。采用描述性统计方法报告疾病控制结局和 CTCAE v4.0-5.0 毒性。采用单变量和多变量 Cox 回归以及逐步回归来确定与生存相关的因素。
中位随访 19.5 个月后，130 例腺癌（AC）（62%）或鳞状细胞癌（SCC）（38%）患者可评估（Ⅱ-Ⅲ期：92%）。患者接受卡铂/紫杉醇（75%）或氟尿嘧啶为基础（25%）的同期化疗。中位总放疗剂量为 50.4Gy（范围，44.7-71.4Gy），分为 28 个分次（24-35 次）。AC 和 SCC 局部区域和远处复发率分别为 30%和 35%、24%和 33%。AC 的中位 OS 和 DFS 分别为 22.9 和 10.7 个月，SCC 分别为 25.7 和 20.2 个月。在逐步回归中，肿瘤分期、DCCRT 期间的喂养管和原发肿瘤 PET/CT SUVmax 的变化与 OS 和 DFS 显著相关。最严重的毒性是急性 4 级血液学细胞减少症（6%）和放射性皮炎（1%）。最常见的急性 3 级毒性是血液学细胞减少症（35%）、吞咽困难（23%）和食欲不振（19%）。
不可切除 EC 采用 DCCRT 治疗的毒性可接受，并可为某些患者提供多年的疾病控制，即使是在 AC 患者中。在大型研究中继续进行随访和调查将是有用的。
