Department of Radiation Oncology and Proton & Radiation Therapy Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Department of Hematology-Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Radiother Oncol. 2021 Apr;157:56-62. doi: 10.1016/j.radonc.2021.01.007. Epub 2021 Jan 19.
The management of cT4b thoracic esophageal cancer (EC) is challenging. The optimal treatment remains unclear, and prospective or large-scale retrospective reports on treatment outcomes are lacking. The present study was conducted to investigate the treatment outcomes, failure patterns, treatment responses, and prognostic factors focusing on cT4b thoracic EC treated by definitive concurrent chemoradiotherapy (dCRT).
A retrospective review of cT4b thoracic EC patients treated with curative intent dCRT at our institution between 2009 and 2017 was conducted. Survival analysis was calculated using the Kaplan-Meier method, and prognostic factors were examined by the Cox proportional hazards model.
A total of 95 cT4b EC patients were included, and the median survival was 11.4 months. The 1-year, 3-year, and 5-year survival rates were 49.4%, 22.2%, and 19.0%, respectively. Forty-six patients (48.4%) experienced locoregional failure, 3 patients (3.2%) developed distant metastasis, and 11 patients had synchronous locoregional and distant failure. The corresponding 1-year, 3-year, and 5-year locoregional failure rates were 62.6%, 74.5%, and 79.2%, respectively. The treatment response rate was 76.9%, and clinical complete response was achieved in 25.3% of patients. Multivariable analysis revealed that age ≤ 65 (p = 0.003), pre-dCRT body mass index (BMI) > 21 (p < 0.001), clinical N stage 0-1 (p = 0.014), and tumor length ≤ 6 cm (p = 0.026) were independent prognosticators for better survival.
Our study revealed that long-term survival is achievable for cT4b EC patients treated by dCRT, with a 3-year survival rate of more than 20%. Locoregional recurrence was the most common failure pattern. Age, BMI, N stage, and tumor length were significant prognosticators for survival in this group of patients.
cT4b 期胸段食管癌（EC）的治疗具有挑战性。目前尚不清楚最佳的治疗方法，也缺乏针对该疾病的前瞻性或大规模回顾性治疗结果报告。本研究旨在探讨 cT4b 期胸段 EC 患者采用根治性同步放化疗（dCRT）的治疗效果、失败模式、治疗反应和预后因素。
回顾性分析 2009 年至 2017 年期间在我院接受根治性 dCRT 治疗的 cT4b 期胸段 EC 患者。采用 Kaplan-Meier 法计算生存分析，采用 Cox 比例风险模型分析预后因素。
共纳入 95 例 cT4b EC 患者，中位生存时间为 11.4 个月。1 年、3 年和 5 年生存率分别为 49.4%、22.2%和 19.0%。46 例（48.4%）患者发生局部区域失败，3 例（3.2%）发生远处转移，11 例患者同时发生局部区域和远处转移。相应的 1 年、3 年和 5 年局部区域失败率分别为 62.6%、74.5%和 79.2%。治疗反应率为 76.9%，25.3%的患者获得临床完全缓解。多变量分析显示，年龄≤65 岁（p=0.003）、dCRT 前 BMI＞21（p＜0.001）、临床 N 分期 0-1 期（p=0.014）和肿瘤长度≤6cm（p=0.026）是生存的独立预后因素。
本研究表明，dCRT 治疗可使 cT4b 期 EC 患者获得长期生存，3 年生存率超过 20%。局部区域复发是最常见的失败模式。年龄、BMI、N 分期和肿瘤长度是该组患者生存的显著预后因素。
