Department of Radiation, Shijiazhuang People's Hospital, Shijiazhuang, China.
Department of Radiation Oncology, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China.
Ann Palliat Med. 2021 Sep;10(9):9467-9479. doi: 10.21037/apm-21-2080.
To explore the benefits of different types of irradiation on patients with postoperative locoregional recurrence (LRR) of thoracic esophageal squamous cell carcinoma (ESCC).
We analyzed the medical records of 344 patients with recurrent esophageal cancer (EC) at the Fourth Hospital of Hebei Medical University. All patients met an inclusion criteria that included having postoperative LRR (without distant metastasis), and having received either chemotherapy, radiotherapy, or chemoradiotherapy after LRR. Patients either received elective nodal irradiation (ENI) or involved field irradiation (IFI), with a stratified analysis performed on both groups. SPSS 19.0 software (IBM Corporation, Armonk, NY USA) was then used for statistical analysis.
The median overall survival time of all patients after surgery was 33 months [95% confidence interval (CI): 28.3-37.7 months]; the median overall survival time of patients after recurrence after radiotherapy was 12.8 months (95% CI: 11.3-14.3 months). There were 276 cases (80.2%) of single local recurrence after surgery, and 68 cases (19.8%) of multiple local recurrence (≥2). The results of our multivariate analysis showed that the patient's gender, log odds of positive lymph nodes (LODDS), and the number of courses of chemotherapy were all independent factors affecting the patient's prognosis (P=0.003, P<0.001, and P<0.001). The results of stratified analysis showed that patients with esophageal lesion length <5.0 cm, stage N0, ≤9 surgically dissected lymph nodes, no positive regional lymph node metastasis (LNM), and LODDS ≤0.030 could benefit from ENI treatment (X2=4.208, P=0.032; X2=6.262, P=0.012; X2=10.359, P=0.001; X2=6.327, P=0.012; X2=6.026, P=0.014); and patients with ≥16 surgically dissected lymph nodes could benefit from IFI treatment (X2=4.429, P=0.035).
Chemotherapy, radiotherapy, and chemoradiotherapy are all effective modes of treatment for patients with postoperative LRR of EC. Patients with shorter esophageal lesions determined by preoperative esophagography, earlier postoperative pathological N staging, lower LODDS scores, and fewer surgically dissected lymph nodes might benefit more from ENI treatment than from IFI. However, patients with a larger number of lymph nodes dissected during surgery might benefit more from IFI treatment. To further confirm this study's conclusions, multiple prospective studies should be undertaken in the future.
探讨不同类型照射对胸段食管鳞癌（ESCC）术后局部区域复发（LRR）患者的益处。
我们分析了河北医科大学第四医院 344 例复发性食管癌（EC）患者的病历。所有患者均符合纳入标准，包括术后 LRR（无远处转移），且在 LRR 后接受化疗、放疗或放化疗。患者接受选择性淋巴结照射（ENI）或累及野照射（IFI），对两组进行分层分析。然后使用 SPSS 19.0 软件（IBM 公司，美国纽约州阿蒙克）进行统计分析。
所有患者术后中位总生存时间为 33 个月[95%置信区间（CI）：28.3-37.7 个月]；放疗后复发患者的中位总生存时间为 12.8 个月（95%CI：11.3-14.3 个月）。术后单局部复发 276 例（80.2%），多局部复发（≥2 处）68 例（19.8%）。多因素分析结果显示，患者性别、阳性淋巴结对数优势（LODDS）和化疗疗程数均为影响患者预后的独立因素（P=0.003，P<0.001 和 P<0.001）。分层分析结果显示，食管病变长度<5.0 cm、N0 期、手术清扫淋巴结数≤9、无区域淋巴结转移（LNM）阳性、LODDS≤0.030 的患者，ENI 治疗可获益（X2=4.208，P=0.032；X2=6.262，P=0.012；X2=10.359，P=0.001；X2=6.327，P=0.012；X2=6.026，P=0.014）；手术清扫淋巴结数≥16 个的患者 IFI 治疗可获益（X2=4.429，P=0.035）。
化疗、放疗和放化疗均为 EC 术后 LRR 患者的有效治疗模式。术前食管造影确定的食管病变较短、术后病理 N 分期较早、LODDS 评分较低、手术清扫淋巴结数较少的患者，ENI 治疗可能优于 IFI 治疗。然而，手术中清扫淋巴结较多的患者可能从 IFI 治疗中获益更多。为了进一步证实本研究的结论，未来应开展多项前瞻性研究。
