Department of Radiation Oncology, Xijing Hospital, Air Force Medical University, Xi'an, 710032, Shaanxi, China.
Department of Gastrointestinal Surgery, Xijing Hospital, Air Force Medical University, Xi'an, 710032, Shaanxi, China.
Radiat Oncol. 2023 Jul 10;18(1):114. doi: 10.1186/s13014-023-02265-w.
Local primary-recurrence of esophageal squamous cell carcinoma (ESCC) after definitive treatment has the potential for increasing overall survival with re-irradiation (Re-RT), especially with advanced technique. This study aimed to evaluate the efficacy and toxicities of Re-RT using intensity-modulated radiotherapy (IMRT)/volumetric modulated arc therapy (VMAT) for local primary-recurrence of ESCC.
A total of 130 ESCC patients with local primary-recurrence from Xijing hospital between 2008 and 2021 were enrolled and 30 patients underwent IMRT/VMAT based salvage Re-RT. Cox regression analysis was used to analyze the prognostic factors for overall survival (OS) and after recurrence survival (ARS). The toxicities of 30 patients receiving Re-RT were also assessed.
The median OS and ARS of the 130 recurrent patients were 21 months (1-164 months) and 6 months (1-142 months). The 1-, 2-, and 3-year OS rates were 81.5%, 39.2%, and 23.8%, respectively. Besides, the 1-, 2-, and 3-year ARS rates were 30.0%, 10%, and 6.2%. Multivariate analysis showed that Re-RT ± chemotherapy (p = 0.043) and chemotherapy alone (p < 0.001) and esophageal stents (p = 0.004) were independent prognostic factors for OS. The median OS of 30 patients treated with Re-RT were significantly better than that of 29 patients treated with chemotherapy (34.5 months vs. 22 months, p = 0.030). Among 30 ESCC patients treated with Re-RT, the median OS and ARS were 34.5 months (range 12-163 months) and 6 months (range 1-132 months), respectively. The recurrence-free interval (RFI) (> 12 months) and initial radiation dose (> 60 Gy) were significantly associated with improved OS. Radiation esophagitis (Grade 1-2) occurred in 16 patients and myelosuppression (Grade1-2) occurred in 10 patients. Grade 3 toxicities (radiation esophagitis and myelosuppression) were only 13.3%. There were no grade 4 toxicities.
Our results demonstrated that IMRT/VMAT-based Re-RT was an effective therapeutic option for ESCC patients with local primary-recurrence compared with chemotherapy alone or without any treatment. Re-RT had improved OS but unfavorable ARS.
根治性治疗后食管鳞状细胞癌（ESCC）局部复发有通过再放疗（Re-RT）提高总生存率的潜力，尤其是采用先进技术。本研究旨在评估再放疗（Re-RT）使用调强放疗（IMRT）/容积旋转调强放疗（VMAT）治疗 ESCC 局部复发的疗效和毒性。
回顾性分析 2008 年至 2021 年在西京医院因局部复发的 130 例 ESCC 患者，其中 30 例患者接受 IMRT/VMAT 为基础的挽救性 Re-RT。采用 Cox 回归分析对总生存（OS）和复发后生存（ARS）的预后因素进行分析。还评估了 30 例接受 Re-RT 治疗的患者的毒性。
130 例复发患者的中位 OS 和 ARS 分别为 21 个月（1-164 个月）和 6 个月（1-142 个月）。1、2、3 年 OS 率分别为 81.5%、39.2%和 23.8%。此外，1、2、3 年 ARS 率分别为 30.0%、10%和 6.2%。多因素分析显示，Re-RT±化疗（p=0.043）和单纯化疗（p<0.001）以及食管支架（p=0.004）是 OS 的独立预后因素。接受 Re-RT 治疗的 30 例患者的中位 OS 明显优于接受化疗的 29 例患者（34.5 个月 vs. 22 个月，p=0.030）。30 例接受 Re-RT 治疗的 ESCC 患者中，中位 OS 和 ARS 分别为 34.5 个月（范围 12-163 个月）和 6 个月（范围 1-132 个月）。复发间隔时间（RFI）（>12 个月）和初始放疗剂量（>60 Gy）与 OS 改善显著相关。16 例患者发生 1-2 级放射性食管炎，10 例患者发生 1-2 级骨髓抑制。仅发生 3 级毒性（放射性食管炎和骨髓抑制）的比例为 13.3%。没有 4 级毒性。
与单纯化疗或不治疗相比，基于调强放疗（IMRT）/容积旋转调强放疗（VMAT）的再放疗（Re-RT）是治疗 ESCC 局部复发患者的有效治疗选择。Re-RT 提高了 OS，但 ARS 不利。
