Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Medical Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Radiother Oncol. 2021 Sep;162:112-118. doi: 10.1016/j.radonc.2021.07.006. Epub 2021 Jul 13.
This study aimed to determine the equivalence between definitive chemoradiotherapy (DCRT) and radical esophagectomy in clinical T1bN0M0 esophageal squamous cell carcinoma (ESCC).
Among 282 patients with cT1bN0M0 ESCC, 238 underwent radical esophagectomy and 44 underwent DCRT. Both treatments were retrospectively compared overall survival (OS), progression-free survival (PFS), and complications.
The DCRT group exhibited poorer patient characteristics than the surgery group, especially with mean age (73 vs. 63 years), Eastern Cooperative Oncology Group (ECOG) status, and Charlson Comorbidity Index (p < 0.001, each). The median follow-up duration was 49.5 (range, 0.4-97.0) and 45.5 months (range, 5.0-112.0) in the surgery and DCRT groups, respectively. In the DCRT group, clinical complete response was achieved in 43 patients (97.7%) at 1 month after treatment. The 5-year OS rates were 75.8% and 68.8% (p = 0.135) and the 5-year PFS were 63.8% and 57.8% (p = 0.637) for the surgery and DCRT groups, respectively. Local recurrence rates were identical between the two groups (11.4% and 11.4%), but the distant metastasis rate was lower in the DCRT group (n = 1, 2.27% vs. n = 29, 12.15%). Grade 3-4 hematologic toxicities were observed in 11 patients (25%) of the DCRT group, and 56 patients (23.5%) in the surgery group showed grade 3-5 surgical complications, including mortality (n = 5).
Based on the non-inferior survival rates, recurrence patterns, and complication rates without critical surgical mortality, DCRT was comparable to esophagectomy for cT1bN0 esophageal squamous cell carcinoma.
本研究旨在确定在临床 T1bN0M0 食管鳞癌（ESCC）中，根治性放化疗（DCRT）与根治性食管切除术的等效性。
在 282 例 cT1bN0M0 ESCC 患者中，238 例行根治性食管切除术，44 例行 DCRT。回顾性比较两组患者的总生存（OS）、无进展生存（PFS）和并发症。
DCRT 组患者的特征明显不如手术组，特别是平均年龄（73 岁比 63 岁）、东部肿瘤协作组（ECOG）状态和 Charlson 合并症指数（p<0.001，每项）。手术组和 DCRT 组的中位随访时间分别为 49.5（0.4-97.0）和 45.5 个月（5.0-112.0）。DCRT 组患者治疗后 1 个月，临床完全缓解率达到 97.7%（43 例）。手术组和 DCRT 组的 5 年 OS 率分别为 75.8%和 68.8%（p=0.135），5 年 PFS 率分别为 63.8%和 57.8%（p=0.637）。两组局部复发率相同（11.4%和 11.4%），但 DCRT 组远处转移率较低（n=1，2.27%比 n=29，12.15%）。DCRT 组有 11 例（25%）出现 3-4 级血液学毒性，手术组有 56 例（23.5%）出现 3-5 级手术并发症，包括死亡（n=5）。
根据非劣效生存率、复发模式和并发症率，不考虑严重手术死亡率，DCRT 与 cT1bN0 食管鳞癌的根治性食管切除术相当。
