Department of Radiation Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka-city, Osaka, 541-8567, Japan.
Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan.
BMC Cancer. 2022 Mar 21;22(1):301. doi: 10.1186/s12885-022-09418-2.
The optimal radiation dose for treating non-metastatic superficial esophageal squamous cell carcinoma is unknown. In this retrospective observational study, we investigated the influence of radiation dose and pretreatment endoscopic prediction of tumor invasion depth on local recurrence after definitive chemoradiotherapy in patients with superficial esophageal squamous cell carcinoma.
We analyzed 134 patients with clinical Tis-T1N0M0 esophageal squamous cell carcinoma who underwent chemoradiotherapy at our institution between 2006 and 2019. Patients were grouped into standard-dose (50.0-50.4 Gy) and high-dose (60.0 Gy) radiotherapy groups. The outcomes of interest were local recurrence and major local recurrence (endoscopically unresectable local recurrent tumors). Kaplan-Meier analysis and the log-rank test were used with propensity score and inverse probability of treatment weighting. Cox proportional hazards analysis was performed to identify predictors of local recurrence and major local recurrence.
The median follow-up times were 52 and 84 months for the standard-dose and high-dose groups, respectively. The adjusted 3-year local recurrence and major local recurrence rates in the standard-dose and high-dose groups were 33.8 and 9.6% (adjusted hazard ratio, 4.00 [95% confidence interval: 1.64-9.73]; adjusted log-rank p = 0.001) and 12.5 and 4.7% (adjusted hazard ratio, 3.13 [95% confidence interval: 0.91-10.81]; adjusted log-rank p = 0.098), respectively. Cox proportional hazards analysis showed that standard-dose radiotherapy and endoscopic findings of deep submucosal invasion are independently associated with local recurrence and major local recurrence.
High-dose radiotherapy is more beneficial for local tumor control than standard-dose radiotherapy in patients with non-metastatic superficial esophageal squamous cell carcinoma. The use of high-dose radiotherapy may merit consideration for tumors with deep submucosal invasion.
治疗非转移性表浅性食管鳞状细胞癌的最佳放射剂量尚不清楚。在这项回顾性观察性研究中，我们研究了根治性放化疗后，放射剂量和肿瘤侵犯深度的预处理内镜预测对表浅性食管鳞状细胞癌局部复发的影响。
我们分析了 2006 年至 2019 年在我院接受放化疗的 134 例临床Tis-T1N0M0 食管鳞状细胞癌患者。患者分为标准剂量（50.0-50.4Gy）和高剂量（60.0Gy）放疗组。主要观察终点为局部复发和主要局部复发（内镜下不可切除的局部复发性肿瘤）。采用倾向性评分和逆概率处理加权法进行 Kaplan-Meier 分析和对数秩检验。采用 Cox 比例风险分析确定局部复发和主要局部复发的预测因素。
标准剂量组和高剂量组的中位随访时间分别为 52 个月和 84 个月。标准剂量组和高剂量组调整后的 3 年局部复发和主要局部复发率分别为 33.8%和 9.6%（调整后的危险比为 4.00 [95%可信区间：1.64-9.73]；调整后的对数秩检验 p=0.001）和 12.5%和 4.7%（调整后的危险比为 3.13 [95%可信区间：0.91-10.81]；调整后的对数秩检验 p=0.098）。Cox 比例风险分析显示，标准剂量放疗和内镜下发现黏膜下深层侵犯与局部复发和主要局部复发独立相关。
与标准剂量放疗相比，非转移性表浅性食管鳞状细胞癌患者接受高剂量放疗更有利于局部肿瘤控制。对于黏膜下深层侵犯的肿瘤，可能需要考虑使用高剂量放疗。
