Zhu Huiping, Lu Xiaoling, Jiang Jian, Lu Jingfeng, Sun Xinchen, Zuo Yun
Department of Oncology, the Affiliated Zhangjiagang Hospital of Soochow University, Suzhou, China.
Department of Radiation Oncology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Dose Response. 2022 Mar 3;20(1):15593258221076720. doi: 10.1177/15593258221076720. eCollection 2022 Jan-Mar.
This study was conducted to explore the appropriate radical radiation dose in concurrent chemoradiotherapy (CCRT) for patients with inoperable stage II-III esophageal squamous cell carcinoma (ESCC).
This retrospective study included patients with esophageal cancer (EC) from the database of patients treated at the Affiliated Zhangjiagang Hospital of Soochow University (1/2015-12/2019). Overall survival (OS), progression-free survival (PFS), objective remission rate (ORR), first failure pattern, and toxicities were collected.
112 patients treated with intensity-modulated radiation therapy (IMRT) combined with concurrent chemotherapy of nedaplatin-based regimens were included. Fifty-eight (51.8%) and 54 (48.2%) patients received 60 (HD) and 50.4 (LD) Gy of radiotherapy, respectively. The HD group showed superior OS and a trend for longer PFS compared with the LD group (median OS: 25.5 vs 17.5 months, P = .021; median PFS: 14.0 vs 10.5 months, P = .076). There were more patients with a complete remission (CR) in the HD group than in the LD group (P=.016). The treatment-related toxicities were generally acceptable, but HD radiotherapy would increase the incidence of grade ≥3 late radiotoxicity (22.4% vs 5.6%, P = .011).
In nedaplatin-based CCRT for stage II-III ESCC, the radiotherapy dose of 60 Gy achieved a better prognosis.
A comparative study of 50.4 Gy and 60 Gy was conducted to evaluate whether 50.4 Gy can be used as a radical radiotherapy dose for inoperable stage II-III esophageal squamous cell carcinoma from a real-world perspective.The highly consistent selection criteria in our study make analysis results highly reliable and scientific.The existing research results support that nedaplatin can be used in concurrent chemoradiotherapy for esophageal squamous cell carcinoma, and this study focuses on the discovery of a better nedaplatin-based combination regimen.The findings of this study are limited to a single-center study with a non-large sample size.Inevitably, recall bias may exist in this retrospective study.Surgery was not involved in the follow-up treatment after concurrent chemoradiotherapy, which may worsen the prognosis of some patients.
本研究旨在探讨不可切除的II-III期食管鳞状细胞癌（ESCC）患者同步放化疗（CCRT）中的合适根治性放疗剂量。
本回顾性研究纳入了苏州大学附属张家港医院（2015年1月至2019年12月）数据库中食管癌（EC）患者。收集总生存期（OS）、无进展生存期（PFS）、客观缓解率（ORR）、首次失败模式和毒性反应。
纳入112例接受调强放疗（IMRT）联合奈达铂方案同步化疗的患者。分别有58例（51.8%）和54例（48.2%）患者接受了60（高剂量组，HD）和50.4（低剂量组，LD）Gy的放疗。与低剂量组相比，高剂量组显示出更好的总生存期和更长无进展生存期的趋势（中位总生存期：25.5个月对17.5个月，P = 0.021；中位无进展生存期：14.0个月对10.5个月，P = 0.076）。高剂量组完全缓解（CR）的患者比低剂量组更多（P = 0.016）。治疗相关毒性反应总体可接受，但高剂量放疗会增加≥3级晚期放射毒性的发生率（22.4%对5.6%，P = 0.011）。
在基于奈达铂的II-III期ESCC同步放化疗中，60 Gy的放疗剂量可获得更好的预后。
进行了50.4 Gy和60 Gy的对比研究，从真实世界角度评估50.4 Gy是否可作为不可切除的II-III期食管鳞状细胞癌的根治性放疗剂量。本研究中高度一致的选择标准使分析结果高度可靠且科学。现有研究结果支持奈达铂可用于食管鳞状细胞癌的同步放化疗，本研究重点在于发现更好的基于奈达铂的联合方案。本研究结果限于单中心、非大样本量研究。不可避免地，本回顾性研究可能存在回忆偏倚。同步放化疗后的后续治疗未涉及手术，这可能使部分患者的预后变差。
