Department of Radiotherapy, Cancer Branch of Sanmenxia Central Hospital, Sanmenxia, 472000, China.
Radiat Oncol. 2022 Mar 28;17(1):61. doi: 10.1186/s13014-022-02019-0.
There is currently no standard treatment for locoregional recurrence of esophageal squamous cell carcinoma (ESCC) previously treated with radiotherapy. This study aimed to assess the efficacy and safety of re-irradiation for ESCC patients with locoregional recurrence.
The PubMed, EmBase, and Cochrane library databases were systematically searched for eligible studies published before January 2021. The pooled effect estimates were calculated using the random effects model. Subgroup analyses were conducted to assess the treatment effectiveness of re-irradiation based on specific characteristics.
Nine retrospective studies including 573 ESCC patients with locoregional recurrence were selected. The pooled incidences of the 1-year, 2-year, 3-year, and 5-year survival for patients after re-irradiation were 59% (95% confidence interval [CI]: 35-83; P < 0.001), 25% (95% CI: 16-33; P < 0.001), 25% (95% CI: 4-45; P = 0.017), and 15% (95% CI: 2-27; P = 0.024), respectively. The rates of complete response and local re-recurrence after re-irradiation were 54% (95% CI: 21-88; P = 0.001) and 62% (95% CI: 55-70; P < 0.001), respectively. The median overall survival and local failure-free survival for patients after re-irradiation were 13.94 months (95% CI: 4.18-46.51; P < 0.001) and 11.01 months (95% CI: 5.99-20.22; P < 0.001), respectively. Grade ≥ 3 adverse events of esophageal perforation, tracheoesophageal fistula, and radiation pneumonitis were significantly more common after re-irradiation.
This study found that re-irradiation for ESCC patients with locoregional recurrence after previous radiotherapy was feasible. However, patients should be carefully observed in order to treat associated adverse events, including esophageal perforation, tracheoesophageal fistula, and radiation pneumonitis.
对于既往接受过放射治疗的食管鳞状细胞癌（ESCC）局部区域复发患者，目前尚无标准治疗方法。本研究旨在评估再放疗治疗 ESCC 局部区域复发患者的疗效和安全性。
系统检索了 PubMed、EmBase 和 Cochrane 图书馆数据库中截至 2021 年 1 月发表的符合条件的研究。使用随机效应模型计算汇总效应估计值。进行亚组分析，根据特定特征评估再放疗的治疗效果。
纳入了 9 项回顾性研究，共 573 例 ESCC 局部区域复发患者。再放疗后患者的 1 年、2 年、3 年和 5 年生存率的合并发生率分别为 59%（95%可信区间：35-83；P<0.001）、25%（95%可信区间：16-33；P<0.001）、25%（95%可信区间：4-45；P=0.017）和 15%（95%可信区间：2-27；P=0.024）。再放疗后完全缓解率和局部复发率分别为 54%（95%可信区间：21-88；P=0.001）和 62%（95%可信区间：55-70；P<0.001）。再放疗后患者的中位总生存时间和局部无失败生存时间分别为 13.94 个月（95%可信区间：4.18-46.51；P<0.001）和 11.01 个月（95%可信区间：5.99-20.22；P<0.001）。再放疗后食管穿孔、气管食管瘘和放射性肺炎等≥3 级不良事件明显更为常见。
本研究发现，对于既往接受过放射治疗的 ESCC 局部区域复发患者，再放疗是可行的。然而，为了治疗相关的不良事件，包括食管穿孔、气管食管瘘和放射性肺炎等，应仔细观察患者。
