Zhang-Velten Elizabeth R, Eraj Salman A, Hein David M, Aguilera Todd A, Folkert Michael R, Sanford Nina N
Department of Radiation Oncology, University of Texas Southwestern, Dallas, TX.
Adv Radiat Oncol. 2020 Oct 9;6(2):100580. doi: 10.1016/j.adro.2020.09.020. eCollection 2021 Mar-Apr.
Although single-institution series suggest potential benefit to dose escalation in definitive radiation therapy for esophageal cancer, randomized trials including intergroup-0123 and the recently presented A Randomized Trial of Dose Escalation in definitive Chemoradiotherapy for patients with Oesophageal cancer (ARTDECO) trial showed no improvement in outcomes with higher radiation therapy dose. As such, there may be significant variation in radiation dose for definitive treatment of esophageal cancer.
The National Cancer Database was used to identify patients who received a diagnosis of nonmetastatic T2+ esophageal cancer between 2006 and 2016 who did not receive definitive surgery and were treated with chemotherapy and radiation therapy doses between 41.4 and 74 Gy. Multivariable logistic regression defined adjusted odds ratios (AORs) of receipt of >50.4 Gy, including year of diagnosis (2006-2013 vs 2014-2016) ∗ histology (squamous cell carcinoma [SCC] vs adenocarcinoma) and year of diagnosis (2006-2013 vs 2014-2016) ∗ disease site (cervical esophagus vs noncervical esophagus) interaction terms, to assess whether the effect of diagnosis year on dose varied by histology and disease site, respectively.
Among 14,517 patients, the most common dose was 50.4 Gy, used for 6955 (47.9%) patients. Dose escalation above 50.4 Gy was observed in 4440 (30.6%) patients and declined by year, from 42.2% in 2006 to 23.5% in 2016. Patients with SCC versus adenocarcinoma had higher odds of dose escalation (39.3% vs 23.8%; AOR 1.46; < .001), as did those with cervical esophageal primaries versus other primary sites (54.9% vs 27.4%; AOR 2.51; < .001). The effect of later diagnosis year was greater for adenocarcinoma than for SCC (pint = 0.001, AOR 0.54, < .001 vs AOR 0.71, < .001) and significant for noncervical esophagus but not cervical esophagus (pint <0.001, AOR 0.56, < .001 vs AOR 0.95, = .616).
Dose escalation in definitive chemoradiotherapy for esophageal cancer declined over time, particularly for adenocarcinoma histology and noncervical primary site. Given the recent results of ARTDECO, our findings can serve as a benchmark from which to measure future shifts in practice patterns.
尽管单机构研究系列提示在食管癌根治性放射治疗中增加剂量可能有益，但包括0123组间研究和最近公布的食管癌根治性放化疗剂量递增随机试验（ARTDECO试验）在内的随机试验显示，更高的放射治疗剂量并未改善预后。因此，食管癌根治性治疗的放射剂量可能存在显著差异。
利用国家癌症数据库识别2006年至2016年间诊断为非转移性T2+食管癌、未接受根治性手术且接受41.4至74 Gy化疗和放射治疗剂量的患者。多变量逻辑回归定义了接受>50.4 Gy的调整优势比（AOR），包括诊断年份（2006 - 2013年与2014 - 2016年）∗组织学（鳞状细胞癌[SCC]与腺癌）以及诊断年份（2006 - 2013年与2014 - 2016年）∗疾病部位（颈段食管与非颈段食管）交互项，以分别评估诊断年份对剂量的影响是否因组织学和疾病部位而异。
在14517例患者中，最常用的剂量是50.4 Gy，6955例（47.9%）患者使用该剂量。4440例（30.6%）患者的剂量超过50.4 Gy，且随年份下降，从2006年的42.2%降至2016年的23.5%。SCC患者与腺癌患者相比，剂量增加的几率更高（39.3%对23.8%；AOR 1.46；P<0.001），颈段食管原发患者与其他原发部位患者相比也是如此（54.9%对27.4%；AOR 2.51；P<0.001）。腺癌患者较SCC患者，诊断年份较晚的影响更大（P交互 = 0.001，AOR 0.54，P<0.001对比AOR 0.71，P<0.001），对于非颈段食管有显著影响，但对颈段食管无显著影响（P交互<0.001，AOR 0.56，P<0.001对比AOR 0.95，P = 0.616）。
食管癌根治性放化疗中的剂量增加随时间下降，尤其是腺癌组织学类型和非颈段原发部位。鉴于ARTDECO试验的最新结果，我们的发现可作为衡量未来实践模式变化的基准。
