Zhang Chi, Ge Xiao-Lin, Huang Chen-Jun, Zhang Shu, Sun Xin-Chen
Department of Radiation Oncology, The First Affiliated Hospital With Nanjing Medical University, Nanjing, China.
Department of Thoracic Surgery, The First Affiliated Hospital With Nanjing Medical University, Nanjing, China.
Front Oncol. 2021 Mar 19;11:638521. doi: 10.3389/fonc.2021.638521. eCollection 2021.
Recurrence of esophageal squamous cell carcinoma (ESCC) in regional lymph nodes (LNs) after surgical section can be treated with salvage resection, radiotherapy (RT) or chemoradiotherapy (CRT). RT or CRT is more widely used in clinic. This paper investigates the effects, toxicities and prognostic risk factors of salvage RT or CRT on patients with LN recurrence. We retrospectively analyzed the clinical outcomes of 103 patients receiving salvage RT or CRT for LN recurrence after ESCC resection. In total, 39 patients received RT alone and 64 received concurrent CRT. All the patients received intensity modulated radiation therapy (IMRT), administered with a median dose of 62 Gy (range, 50-70 Gy). The median follow-up time was 44.5 months, and median survival was 22.5 months (5.5-99.5 months). One-, 3-, and 5-year overall survival (OS) were 80.6, 37.0, and 25.8%, respectively. One- and 2-year progression free survival (PFS) were 57.3 and 34.0%, respectively. Grade 3 or above toxicity was low (16.5%) and no treatment-related deaths occurred. In univariate analysis of OS, pN0 ( = 0.039), smaller LN volume (≤25 cm, = 0.019), combined chemotherapy ( = 0.041) and single LN recurrence ( = 0.001) were associated with prolonged OS. And pT1-2 ( = 0.044), pN0 ( = 0.042), irradiation dose (>60 Gy, = 0.044), combined chemotherapy ( = 0.019) and single LN recurrence ( = 0.002) were associated with prolonged PFS. In multivariate analysis, the patients with only one recurrent node had a significant better OS (HR = 0.556, 95% CI 0.324-0.956, = 0.034) and PFS (HR = 0.528, 95% CI 0.339-0.847, = 0.008). Salvage RT or CRT for regional LN recurrence is effective and acceptable. Fewer recurrent nodes may indicate a better long-term survival.
手术切除后食管鳞状细胞癌（ESCC）区域淋巴结（LN）复发可采用挽救性切除、放疗（RT）或放化疗（CRT）进行治疗。RT或CRT在临床上应用更为广泛。本文探讨挽救性RT或CRT对LN复发患者的疗效、毒性及预后危险因素。我们回顾性分析了103例接受ESCC切除术后LN复发的挽救性RT或CRT患者的临床结局。其中，39例患者仅接受RT，64例接受同步CRT。所有患者均接受调强放疗（IMRT），中位剂量为62 Gy（范围50 - 70 Gy）。中位随访时间为44.5个月，中位生存期为22.5个月（5.5 - 99.5个月）。1年、3年和5年总生存率（OS）分别为80.6%、37.0%和百分之25.8。1年和2年无进展生存率（PFS）分别为57.3%和34.0%。3级及以上毒性较低（16.5%），且未发生与治疗相关的死亡。在OS的单因素分析中，pN0（ = 0.039）、较小的LN体积（≤25 cm， = 0.019）、联合化疗（ = 0.041）和单个LN复发（ = 0.001）与OS延长相关。而pT1 - 2（ = 0.044）、pN0（ = 0.042）、照射剂量（>60 Gy， = 0.044）、联合化疗（ = 0.019）和单个LN复发（ = 0.002）与PFS延长相关。在多因素分析中，仅有一个复发淋巴结的患者OS（HR = 0.556，95%CI 0.324 - 0.956， = 0.034）和PFS（HR = 0.528，95%CI 0.339 - 0.847， = 0.008）显著更好。挽救性RT或CRT治疗区域LN复发有效且可接受。较少的复发淋巴结可能预示着更好的长期生存。
