Deng Jiaying, Xia Yi, Chen Yun, Liu Qi, Chen Weiwei, Zhao Kuaile
Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.
Transl Cancer Res. 2020 Apr;9(4):2287-2294. doi: 10.21037/tcr.2020.03.47.
Radiotherapy plays an important role in multidisciplinary treatment of esophageal squamous cell carcinoma (ESCC). However, the long term prognosis, relapse and metastasis of patients who received radiotherapy with different radiotherapy technique and fractions were unclear. The objective of the present study was to investigate the correlation of them.
Six prospective studies were conducted in succession including 475 locally advanced ESCC patients received two-dimensional (2D) and three-dimensional (3D) radiotherapy with late course accelerated hyperfractionated fraction (LCAF) and continuous accelerated hyperfractionated fraction (CAHF). Overall survival was analyzed using the Kaplan-Meier method. Research regarding the incidence of Grade 3 or higher acute radiation-related toxicity was conducted. Details of relapse and metastasis were also investigated.
The median follow-up time was 57.5 months. The overall incidence of failure was 49%. No significant survival difference was observed in both LACF CAHF and 2DRT 3DRT groups (P=0.55 and 0.64, respectively). Fewer incidences of acute toxicities were observed in ESCC patients treated with 3DRT compared with those treated with 2DRT (P<0.01). Fewer acute radiation esophagitis was observed in LCAF comparison of CAHF (P<0.01), however no significant difference of acute radiation pneumonitis was observed. A total of 65 patients were considered to have metastatic disease affecting distant organs: lung (n=39, 8.2%), liver (n=35, 7.4%) and bone (n=21, 4.4%).
About half of patients suffered local/regional failure following radiotherapy. 3DRT reduced acute radiotherapy toxicities compared with 2DRT. LCAF was more tolerant than CAHF.
放射治疗在食管鳞状细胞癌（ESCC）的多学科治疗中发挥着重要作用。然而，接受不同放疗技术和分割方式的患者的长期预后、复发和转移情况尚不清楚。本研究的目的是探讨它们之间的相关性。
连续进行了六项前瞻性研究，包括475例局部晚期ESCC患者，接受二维（2D）和三维（3D）放疗，采用后程加速超分割（LCAF）和连续加速超分割（CAHF）。采用Kaplan-Meier法分析总生存率。对3级或更高急性放射相关毒性的发生率进行了研究。还调查了复发和转移的细节。
中位随访时间为57.5个月。总失败发生率为49%。在LACF与CAHF组以及2DRT与3DRT组中均未观察到显著的生存差异（分别为P = 0.55和0.64）。与接受2DRT治疗的ESCC患者相比，接受3DRT治疗的患者急性毒性发生率更低（P < 0.01）。在LCAF与CAHF的比较中，急性放射性食管炎的发生率更低（P < 0.01），然而急性放射性肺炎未观察到显著差异。共有65例患者被认为有远处器官转移：肺（n = 39，8.2%）、肝（n = 35，7.4%）和骨（n = 21，4.4%）。
约一半的患者在放疗后出现局部/区域失败。与2DRT相比，3DRT降低了急性放疗毒性。LCAF比CAHF更耐受。
