Department of Radiology, University of Yamanashi, Chūō, Yamanashi, Japan.
Thorac Cancer. 2024 Nov;15(33):2365-2374. doi: 10.1111/1759-7714.15468. Epub 2024 Oct 11.
We investigated the clinical outcomes of involved-field high-dose (≥66 Gy) chemoradiotherapy (CRT) combined with respiratory motion management for esophageal squamous cell carcinoma (ESCC).
Patients who underwent definitive CRT for histologically confirmed ESCC in our department between 2012 and 2018 were retrospectively analyzed. Respiratory motion management strategies included breath-holding (63%) and mask immobilization (29%) based on individual measurements of respiratory tumor motion using radiographic fluoroscopy with endoscopically placed clip markers as landmarks. We evaluated patient characteristics, treatment efficacy, failure patterns, and toxicities.
We enrolled 35 patients with a prescribed dose of 66-70 Gy in 33-35 fractions. The overall response rate within 6 months post-CRT was 94.3%; the median follow-up period for survivors was 43 months. The 2-year overall survival (OS), progression-free survival, and locoregional failure-free survival rates were 51.4%, 42.9%, and 42.9%, respectively. A significant difference in OS was observed between patients with and without esophageal fistulas after CRT (p = 0.002, log-rank test). Disease failure occurred in 16 patients (45.7%), including one (2.9%) with out-of-field regional nodal failure. Major grade 3 or higher toxicities included decreased white blood cell count (48.6%), neutrophil count (34.3%), and esophageal stenosis (31.4%). No grade 3 or higher cardiopulmonary toxicities were observed. Bronchial/tracheal tumor compression and a higher radiotherapy dose (70 Gy) were significantly correlated with esophageal fistulas.
Involved-field high-dose CRT with respiratory motion management may be a feasible treatment option for ESCC. However, a comprehensive assessment of esophageal fistula risk is required to identify suitable candidates.
我们研究了累及野高剂量（≥66Gy）放化疗（CRT）联合呼吸运动管理治疗食管鳞癌（ESCC）的临床结果。
回顾性分析 2012 年至 2018 年期间在我科接受根治性 CRT 的组织学证实为 ESCC 的患者。呼吸运动管理策略包括基于放射透视带有内镜放置夹标记的呼吸肿瘤运动的个体测量的屏气（63%）和面罩固定（29%）。我们评估了患者特征、治疗效果、失败模式和毒性。
我们纳入了 35 名接受 66-70Gy 规定剂量的患者，分为 33-35 个分次。CRT 后 6 个月内的总体缓解率为 94.3%；幸存者的中位随访时间为 43 个月。2 年总生存率（OS）、无进展生存率和局部区域失败无生存率分别为 51.4%、42.9%和 42.9%。CRT 后有无食管瘘的患者 OS 有显著差异（p=0.002，log-rank 检验）。16 例患者（45.7%）发生疾病失败，包括 1 例（2.9%）出现野外区域淋巴结失败。主要 3 级或以上毒性包括白细胞计数减少（48.6%）、中性粒细胞计数减少（34.3%）和食管狭窄（31.4%）。未观察到 3 级或以上心肺毒性。支气管/气管肿瘤压迫和更高的放疗剂量（70Gy）与食管瘘显著相关。
累及野高剂量 CRT 联合呼吸运动管理可能是治疗 ESCC 的一种可行方法。然而，需要全面评估食管瘘风险，以确定合适的患者。
