Innocente Roberto, Navarria Federico, Petri Roberto, Palazzari Elisa, Vecchiato Massimo, Polesel Jerry, Ziccarelli Antonio, Martino Antonio, Ubiali Paolo, Tonin Dino, Lauretta Andrea, Belluco Claudio, Foltran Luisa, Buonadonna Angela, Lleshi Arben, Colombo Carlotta Benedetta, Barresi Loredana, Gigante Marco, Franchin Giovanni, De Paoli Antonino
Radiation Oncology Department, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy.
General Surgery Department, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy.
Front Oncol. 2021 Feb 18;11:626275. doi: 10.3389/fonc.2021.626275. eCollection 2021.
To explore the feasibility and efficacy of a dose intensification with Intensity Modulated Radiation Therapy and Simultaneous Integrated Boost (IMRT-SIB) in locally advanced esophageal and gastroesophageal cancer (GEJ).
We retrospectively analyzed a series of 69 patients with esophageal or GEJ cancer treated at our Institute, between 2016 and 2019, with preoperative IMRT and SIB up to 52.5-54 Gy in 25 fractions in 5 weeks and concurrent carboplatin (AUC2) and paclitaxel (50 mg/m), as in the CROSS regimen.
All patients completed the planned IMRT-SIB program with a median of four (range 1-5) cycles of concurrent paclitaxel/carboplatin. Compliance to IMRT-SIB was 93%, whereas 54% of patients received four to five cycles and 87% at least three cycles of concurrent carboplatin/paclitaxel. Grade 3 toxicity was reported in 19% of patients. Complete clinical response (cCR) was achieved in 48%, and 13% had disease progression after chemoradiation (CRT). Overall, 49% of patients underwent surgery; reasons for non-operation included cCR in cervical tumor location (10%) or cCR and patient decision (13%). A pathologic complete response (pCR) was achieved in 44% of resected patients. Postoperative complications and mortality rates were 21 and 6%, respectively. At a median follow-up of 12 months (6-25), 2-year overall and progression-free (PFS) survival rates were 81 and 54%, respectively. No difference in PFS by histologic type in operated patients was reported. Non-operated cCR patients had higher PFS, including cervical locations and selected cCR patients who decided for non-operation (75 30%, p < 0.01).
The study reported favorable results in safety and feasibility of the IMRT-SIB dose intensification in our preoperative CRT program. The toxicity was acceptable, allowing a high compliance to intensified radiation doses with dose reduction of concurrent paclitaxel/carboplatin in some patients. The high rate of cCR and pCR suggested this intensified program is effective in the preoperative CRT and, for selected responsive patients, in the non-operative approach to esophageal and GEJ cancer. The 2-year survival rates were promising. A prospective study is being planned to confirm these observations.
探讨调强放射治疗与同步整合加量（IMRT-SIB）剂量强化方案在局部晚期食管癌和胃食管交界癌（GEJ）中的可行性和疗效。
我们回顾性分析了2016年至2019年间在我院接受治疗的69例食管癌或GEJ癌患者，采用术前IMRT和SIB，剂量达52.5 - 54 Gy，分25次，5周完成，同时联合卡铂（AUC2）和紫杉醇（50 mg/m²），如同CROSS方案。
所有患者均完成了计划的IMRT-SIB方案，同时接受紫杉醇/卡铂治疗的周期数中位数为4个（范围1 - 5个）。IMRT-SIB的依从性为93%，而54%的患者接受了4至5个周期的治疗，87%的患者至少接受了3个周期的卡铂/紫杉醇同步治疗。19%的患者报告出现3级毒性反应。48%的患者达到完全临床缓解（cCR），13%的患者在放化疗（CRT）后疾病进展。总体而言，49%的患者接受了手术；未手术的原因包括颈部肿瘤部位达到cCR（10%）或达到cCR且患者决定不手术（13%）。44%的接受手术的患者实现了病理完全缓解（pCR）。术后并发症发生率和死亡率分别为21%和6%。中位随访12个月（6 - 25个月）时，2年总生存率和无进展生存率（PFS）分别为81%和54%。报告显示，手术患者的PFS在组织学类型方面无差异。未手术的cCR患者，包括颈部肿瘤部位以及选择不手术的特定cCR患者，具有更高的PFS（75 ± 30%，p < 0.01）。
本研究报告了在我们的术前CRT方案中，IMRT-SIB剂量强化在安全性和可行性方面取得了良好结果。毒性反应可接受，在部分患者中允许在降低同步紫杉醇/卡铂剂量的情况下，对强化放射剂量有较高的依从性。高cCR率和pCR率表明，这种强化方案在术前CRT中有效，对于部分反应性患者，在食管癌和GEJ癌的非手术治疗方法中也有效。2年生存率令人鼓舞。正在计划进行一项前瞻性研究以证实这些观察结果。
