Department of Radiation and Medical Oncology, Central Hospital of Xianning City, Tongji Xianning Hospital of Huazhong University of Science and Technology, Xianning, China.
Medicine (Baltimore). 2022 Apr 22;101(16):e29166. doi: 10.1097/MD.0000000000029166.
Intensity-modulated radiotherapy (IMRT) is widely applied during the treatment of esophageal squamous cell carcinoma (ESCC), but the optimal radiation dose still lacks a consensus. The aim of this study was to explore the optimal radiation dose for inoperable locally advanced ESCC patients treated with IMRT in a real-world clinical setting.A total of 90 inoperable ESCC patients with locally advanced stages of II-IVA treated with IMRT in our institute between February 1, 2014 and June 30, 2019 were included in this retrospective study. Sixty patients had received >60 Gy (high dose group) and 30 patients had received ≤60 Gy (low dose group). The median radiation dose was 66 Gy (range: 61-70 Gy) and 50.2 Gy (range: 40-60 Gy), respectively. Concurrent chemotherapies were platinum-based regimens.The median progression free survival (PFS) and overall survival (OS) of all patients were 7.6 and 14.1 months, respectively. Patients in the high dose group exhibited a significantly better PFS (1-year PFS 34.6% vs 22.8%; 2-year PFS 11.9% vs 0%, P = .008) and OS (1-year OS 57.5% vs 39.5%; 2-year OS 31.4% vs 15.8%, P = .007). The median PFS in the high and low dose groups were 8.1 and 6.1 months, and the median OS were 15.4 and 8.5 months, respectively. Multivariate Cox analysis showed that radiation dose (>60 Gy vs ≤60 Gy) was independently prognostic factor for OS (HR: 0.44; 95% CI: 0.22-0.89; P = .021), but not for PFS (HR: 0.56; 95% CI: 0.31-1.02; P = .058). There was no significant difference in treatment-related toxicities of grade ≥3 between the 2 groups (P = .402).This retrospective study confirmed that higher radiation dose (>60 Gy) resulted in better survival outcomes for inoperable patients with locally advanced ESCC treated with IMRT.
调强放疗（IMRT）在食管鳞状细胞癌（ESCC）的治疗中得到广泛应用，但最佳放射剂量仍缺乏共识。本研究旨在探讨在真实临床环境中，不可手术局部晚期 ESCC 患者接受 IMRT 治疗的最佳放射剂量。
本回顾性研究纳入了 2014 年 2 月 1 日至 2019 年 6 月 30 日期间在我院接受 IMRT 治疗的 90 例不可手术局部晚期 II-IVA 期 ESCC 患者。其中 60 例患者接受>60Gy（高剂量组），30 例患者接受≤60Gy（低剂量组）。中位放射剂量分别为 66Gy（范围：61-70Gy）和 50.2Gy（范围：40-60Gy）。同步放化疗采用铂类方案。
所有患者的中位无进展生存期（PFS）和总生存期（OS）分别为 7.6 个月和 14.1 个月。高剂量组患者的 PFS（1 年 PFS 34.6%比 22.8%；2 年 PFS 11.9%比 0%，P=0.008）和 OS（1 年 OS 57.5%比 39.5%；2 年 OS 31.4%比 15.8%，P=0.007）显著改善。高剂量组和低剂量组的中位 PFS 分别为 8.1 个月和 6.1 个月，中位 OS 分别为 15.4 个月和 8.5 个月。多因素 Cox 分析显示，放射剂量（>60Gy 比≤60Gy）是 OS 的独立预后因素（HR：0.44；95%CI：0.22-0.89；P=0.021），但不是 PFS（HR：0.56；95%CI：0.31-1.02；P=0.058）的预后因素。两组≥3 级治疗相关毒性无显著差异（P=0.402）。
本回顾性研究证实，对于接受 IMRT 治疗的不可手术局部晚期 ESCC 患者，较高的放射剂量（>60Gy）可带来更好的生存获益。
