Department of radiation oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Biomol Biomed. 2023 Mar 16;23(2):327-334. doi: 10.17305/bjbms.2022.7835.
The aim of this study was to discuss the treatment mode of radical radiotherapy for elderly patients with esophageal cancer. The clinical data of 136 elderly patients (≥60 years old) with esophageal cancer (EC) who received radical intensity-modulated radiotherapy in the Second Affiliated Hospital of Xi'an Jiaotong University from January 2015 to December 2019 were retrospectively analyzed. Cox risk model was used for multivariate prognostic analysis, and Kaplan Meier method was used to calculate progression free survival (PFS) and overall survival (OS). Cox regression analysis showed that ECOG score, basic diseases, T stage, radiation dose, radiation injury and chemotherapy were the prognostic factors of elderly patients. The median OS of the radiotherapy group, concurrent chemoradiotherapy group and sequential chemoradiotherapy group were 17, 41 and 10 months (p=0.009), respectively. The 3-year OS and PFS of concurrent intravenous chemotherapy and oral chemotherapy were 50%, 42.9% and 34.1%, 28.6% (p=0.641, p=0.702), respectively. The median OS of IFI and ENI were 23 and 24 months (p=0.219) and the local recurrence rate were 59.8% and 43.2% (p=0.069), respectively, but the incidence and mortality of radiation pneumonia and esophagitis in ENI were higher. The 3-year OS and PFS the low-dose group (≤60Gy) and high-dose group (>60Gy) were 19.1%, 40.4% and 14.9%, 29.2% (p=0.012, p=0.049), respectively. In conclusion, for elderly patients with inoperable EC, radical chemoradiotherapy should be considered a preferable selection. Among them, oral drugs and high-dose involved field irradiation exhibited better curative effects and safety.
本研究旨在探讨老年食管癌患者根治性放疗的治疗模式。回顾性分析 2015 年 1 月至 2019 年 12 月在西安交通大学第二附属医院接受根治性调强放疗的 136 例老年食管癌（EC）患者的临床资料。采用 Cox 风险模型进行多因素预后分析，Kaplan-Meier 法计算无进展生存（PFS）和总生存（OS）。Cox 回归分析显示，ECOG 评分、基础疾病、T 分期、放疗剂量、放疗损伤和化疗是老年患者的预后因素。放疗组、同期放化疗组和序贯放化疗组的中位 OS 分别为 17、41 和 10 个月（p=0.009）。同期静脉化疗与口服化疗的 3 年 OS 和 PFS 分别为 50%、42.9%和 34.1%、28.6%（p=0.641，p=0.702）。IFI 和 ENI 的中位 OS 分别为 23 和 24 个月（p=0.219），局部复发率分别为 59.8%和 43.2%（p=0.069），但 ENI 的放射性肺炎和食管炎发生率和死亡率较高。低剂量组（≤60Gy）和高剂量组（>60Gy）的 3 年 OS 和 PFS 分别为 19.1%、40.4%和 14.9%、29.2%（p=0.012，p=0.049）。综上所述，对于不能手术的老年 EC 患者，根治性放化疗应作为首选。其中，口服药物和高剂量累及野照射具有更好的疗效和安全性。
