Liu Ruifeng, Zhang Xueliang, Zhang Qiuning, Luo Hongtao, Wei Shihong, Liu Tingting, Sun Shilong, Liu Zhiqiang, Li Zheng, Tian Jinhui, Wang Xiaohu
Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou R.P China, 730000.
Lanzhou Heavy Ion Hospital, Lanzhou R.P China, 730000.
J Cancer. 2021 Mar 31;12(11):3180-3189. doi: 10.7150/jca.50108. eCollection 2021.
To evaluate locoregional failure and its impact on survival by comparing involved field irradiation (IFI) with elective lymph node irradiation (ENI) for patients with esophageal squamous cell cancer who underwent post-operative radiotherapy. The enrolled patients were randomized allocated to IFI or ENI group. CTV of IFI was generated according to pre-operative primary tumor location and post-operative pathological characters and positive LNs regions. CTV of ENI was generated according to pre-operative tumor position to administer selective lymph node irradiation. Radiotherapy planning was delivered using either 3D-CRT or IMRT. A total of 57 patients were enrolled, 28 patients in ENI group and 29 patients in IFI group. There were not statistical differences between two groups in baseline (>0.05). The initial locoregional failure rate was 17.9 % in ENI arm and 20.7% in IFI arm respectively (=0.085). The 1-, 3-, and 5-year Progression-free Survival (PFS) were 63.2, 43.5, and 21.8 % in ENI arm versus 78.2, 60.1, and 55.1% in IFI arm ( =0.038). The 1-, 3-, and 5-year overall survival (OS) were 78.6, 46.9, and 23.5 % in ENI arm versus 72.9, 59.7, and 54.3 % in IFI arm (=0.06). Acute radiation pneumonitis (=0.005) and hematological toxicities ( =0.029) also showed statistical differences between groups, ENI arm was more than IFI arm. The results indicated that IFI tended to improve survival and reduce toxicities for patients with operative ESCC and did not increase locoregional failure compared to ENI. It is thus suggested that IFI for ESCC PORT is worthy of clinical recommendation and further study.
通过比较接受术后放疗的食管鳞状细胞癌患者的累及野照射（IFI）与选择性淋巴结照射（ENI），评估局部区域复发及其对生存的影响。将入组患者随机分配至IFI组或ENI组。IFI的临床靶区（CTV）根据术前原发肿瘤位置、术后病理特征及阳性淋巴结区域确定。ENI的CTV根据术前肿瘤位置进行选择性淋巴结照射确定。采用三维适形放疗（3D-CRT）或调强放疗（IMRT）进行放疗计划。共入组57例患者，ENI组28例，IFI组29例。两组基线时无统计学差异（>0.05）。ENI组和IFI组的初始局部区域复发率分别为17.9%和20.7%（P=0.085）。ENI组1年、3年和5年无进展生存率（PFS）分别为63.2%、43.5%和21.8%，IFI组分别为78.2%、60.1%和55.1%（P=0.038）。ENI组1年、3年和5年总生存率（OS）分别为78.6%、46.9%和23.5%，IFI组分别为72.9%、59.7%和54.3%（P=0.06）。急性放射性肺炎（P=0.005）和血液学毒性（P=0.029）在两组间也存在统计学差异，ENI组高于IFI组。结果表明，与ENI相比，IFI倾向于改善手术切除的食管鳞状细胞癌患者生存率并降低毒性，且不增加局部区域复发。因此，建议食管鳞状细胞癌术后放疗采用IFI值得临床推荐并进一步研究。
