挽救性同期放化疗（三维适形放疗联合氟尿嘧啶/铂类化疗）治疗食管鳞癌术后区域性复发的疗效和生存结果。
Tumor response and survival outcomes of salvage concurrent chemoradiotherapy with three-dimensional conformal radiotherapy and 5-fluorouracil/platinum-based chemotherapy for postoperative locoregional recurrence of esophageal squamous cell carcinoma.
机构信息
Department of Internal Medicine, Komatsu Municipal Hospital, Komatsu, Japan.
Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.
出版信息
Esophagus. 2022 Oct;19(4):645-652. doi: 10.1007/s10388-022-00936-3. Epub 2022 Jul 28.
BACKGROUND
Salvage concurrent chemoradiotherapy is effective against locoregional recurrence after curative resection of esophageal squamous cell carcinoma. However, there is no consensus on its application. We investigated the outcomes of salvage concurrent chemoradiotherapy (60 Gy in 30 fractions) with three-dimensional conformal radiotherapy and 5-fluorouracil/platinum-based chemotherapy.
METHODS
We retrospectively investigated the outcomes and prognostic factors in 51 patients with esophageal squamous cell carcinoma treated with salvage concurrent chemoradiotherapy.
RESULTS
The median follow-up was 17.5 (range, 2.8-116.1) months. The overall response, complete response, and partial response rates were 74.5%, 49.0%, and 25.5%, respectively. The median progression-free survival was 8.2 months; the 3-year progression-free survival rate was 22.9%. The median overall survival was 23.1 months; the 3-year overall survival rate was 40.7%. Overall survival was significantly longer in patients with a complete response than in those without (median overall survival: not reached vs. 15.3 months); 3-year overall survival rate: 62.5% vs. 20.3% (hazard ratio: 0.222; P < 0.001). Multivariate analysis showed that the independent prognostic factor for overall survival was < 25 mm longest diameter of metastatic lymph nodes (hazard ratio: 3.71).
CONCLUSIONS
Salvage concurrent chemoradiotherapy (60 Gy in 30 fractions) with three-dimensional conformal radiotherapy and 5-fluorouracil/platinum-based chemotherapy was an effective and safe treatment for locoregional recurrence after curative resection of esophageal squamous cell carcinoma, especially in those approaching a complete response. Additionally, a shorter longest diameter of metastatic lymph nodes may be associated with better long-term survival.
背景
挽救性同步放化疗对根治性切除后的食管鳞状细胞癌局部区域复发有效。然而，其应用尚无共识。我们研究了三维适形放疗联合 5-氟尿嘧啶/铂类化疗的挽救性同步放化疗（60Gy/30 次）的结果。
方法
我们回顾性研究了 51 例接受挽救性同步放化疗的食管鳞状细胞癌患者的结果和预后因素。
结果
中位随访时间为 17.5 个月（范围为 2.8-116.1 个月）。总体缓解率、完全缓解率和部分缓解率分别为 74.5%、49.0%和 25.5%。无进展生存期的中位数为 8.2 个月；3 年无进展生存率为 22.9%。总生存期的中位数为 23.1 个月；3 年总生存率为 40.7%。完全缓解患者的总生存期明显长于未缓解患者（中位总生存期：未达到 vs. 15.3 个月）；3 年总生存率：62.5% vs. 20.3%（风险比：0.222；P<0.001）。多因素分析显示，总生存的独立预后因素是转移淋巴结最长直径<25mm（风险比：3.71）。
结论
三维适形放疗联合 5-氟尿嘧啶/铂类化疗的挽救性同步放化疗（60Gy/30 次）是根治性切除后食管鳞状细胞癌局部区域复发的有效且安全的治疗方法，特别是在接近完全缓解的患者中。此外，转移淋巴结最长直径较短可能与长期生存更好相关。
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