Department of Radiation Oncology, Seoul National University Hospital, Seoul National University, College of Medicine, Seoul, Republic of Korea; Department of Radiation Oncology, Seoul National University, College of Medicine, Seoul, Republic of Korea.
Proton Therapy Center, National Cancer Center, Goyang, Republic of Korea.
Radiother Oncol. 2023 Dec;189:109936. doi: 10.1016/j.radonc.2023.109936. Epub 2023 Sep 30.
To assess the failure pattern and analyze the treatment scheme of definitive radiation therapy (RT) for T1N0M0 esophageal squamous cell carcinoma (ESCC).
We performed a multi-institutional retrospective analysis in T1N0M0 ESCC patients who underwent definitive RT from 2010 to 2019. Patterns of failure were demonstrated as in-, and out-field locoregional, and distant metastasis. In the analysis, freedom-from locoregional recurrence (FFLRR) and their association with clinicopathologic factors were evaluated. Propensity score matching in cT1b patients was done.
168 patients were included with a median follow-up of 34.0 months, and 26 cT1a, 116 cT1b disease. The rates of 3-year all and locoregional recurrence for cT1a were 30.5% and 24.1% and those for cT1b were 27.1% and 25.9%, respectively. Among 116 cT1b patients, 69 patients received elective nodal irradiation (ENI) and 47 received involved field irradiation (IFI). After propensity score matching, the 3-year FFLRR rate was 84.5%. There was no difference between ENI and IFI in FFLRR (P = 0.831) and OS (P = 0.525). The 3-year FFLRR was 83.8% (95% Confidence interval (CI), 61.8-93.8%) in IFI group and 85.3% (95% CI, 65.1-94.3%) in ENI group. In multivariate analysis, concurrent chemotherapy use was marginally associated with FFLRR (Hazard ratio, 0.16; P = 0.064).
cT1a patients who cannot receive endoscopic resection showed similar failure rates as cT1b patients, questioning the staging accuracy and raised the need for thorough treatment like chemoradiotherapy. In cT1b patients, IFI with 50 to 60 Gy and concurrent chemotherapy could be reasonable.
评估 T1N0M0 食管鳞癌（ESCC）根治性放疗（RT）的失败模式，并分析治疗方案。
我们对 2010 年至 2019 年期间接受根治性 RT 的 T1N0M0 ESCC 患者进行了多机构回顾性分析。失败模式表现为瘤内、瘤旁、区域和远处转移。在分析中，评估了无局部区域复发（FFLRR）及其与临床病理因素的关系。对 cT1b 患者进行倾向评分匹配。
共纳入 168 例患者，中位随访时间为 34.0 个月，其中 26 例 cT1a 期，116 例 cT1b 期。cT1a 期患者的 3 年总生存率和局部区域复发率分别为 30.5%和 24.1%，cT1b 期患者分别为 27.1%和 25.9%。116 例 cT1b 患者中，69 例接受选择性淋巴结照射（ENI），47 例接受累及野照射（IFI）。经过倾向评分匹配后，3 年 FFLRR 率为 84.5%。ENI 和 IFI 在 FFLRR（P=0.831）和 OS（P=0.525）方面无差异。IFI 组的 3 年 FFLRR 为 83.8%（95%置信区间（CI），61.8-93.8%），ENI 组为 85.3%（95% CI，65.1-94.3%）。多因素分析显示，同期化疗的应用与 FFLRR 略有相关（风险比，0.16；P=0.064）。
不能接受内镜切除的 cT1a 患者的失败率与 cT1b 患者相似，这对分期准确性提出了质疑，并需要像放化疗那样进行彻底治疗。在 cT1b 患者中，50 至 60Gy 的 IFI 联合同期化疗可能是合理的。
