Fukuzawa Tsuyoshi, Nagao Ryuta, Kuroki Toshihisa, Mikami Tatsuya, Akiba Takeshi, Nakano Yoji, Toyoda Yuri, Takazawa Tsuyoshi, Matsumoto Yoshitsugu, Kabuki Shigeto, Sugawara Akitomo
Department of Radiation Oncology, Tokai University School of Medicine, Kanagawa, Japan.
Department of Radiation Oncology, Tokai University School of Medicine Hachioji Hospital, Tokyo, Japan.
Rep Pract Oncol Radiother. 2024 Oct 3;29(4):426-436. doi: 10.5603/rpor.101529. eCollection 2024.
The objective was to evaluate the efficacy and safety of radiotherapy and the prognostic factors in patients with esophageal cancer who received definitive radiotherapy, using volumetric modulated arc therapy (VMAT).
Forty-seven patients who received definitive radiotherapy using VMAT between September 2017 and December 2020 were enrolled. Prescription doses were 60 Gy in 30 fractions to the planning target volume (PTV) primary and 48 Gy in 30 fractions to the PTV subclinical. Overall survival (OS), progression free survival (PFS), and toxicity were analyzed, and univariate and multivariate analyses were used to investigate the prognostic factors.
Median follow up time was 10 months. Most of the patients had an advanced disease stage (stage I, 12.8%; II, 8.5%; III, 27.7%; IV, 51.0%) patients (38.3%) had a T4 tumor. The median survival time was 14 months (range: 0-56 months). The 2-year OS and PFS were 31.3% and 20.4%, respectively. Acute adverse events (≥ Grade 3) were observed in 25 patients (53.2%), and the most frequent types were dysphagia, hematological toxicities including leukopenia, and febrile neutropenia in 14 (29.8%), 10 (21%), and 10 (21%) patients, respectively. Late adverse events (Grade 3 or higher) were observed in eight patients (17.0%), and the most frequent types were pneumonitis in four patients (8.5%), and Grade 5 in one patient (2.1%; esophageal fistula). In multivariate analysis, neutrophil-to-lymphocyte ratio (NLR) > 3 (p = 0.026) was significantly associated with poor survival.
Definitive radiotherapy of 60Gy with VMAT is feasible and safe for patients with esophageal cancer. Pre-treatment NLR >3 was an independent prognostic factor for OS.
本研究旨在评估容积调强弧形放疗（VMAT）用于食管癌患者根治性放疗的疗效、安全性及预后因素。
纳入2017年9月至2020年12月期间接受VMAT根治性放疗的47例患者。计划靶区（PTV）原发灶的处方剂量为60Gy，分30次给予；PTV亚临床灶的处方剂量为48Gy，分30次给予。分析总生存期（OS）、无进展生存期（PFS）及毒性反应，并采用单因素和多因素分析来研究预后因素。
中位随访时间为10个月。大多数患者疾病分期较晚（I期，12.8%；II期，8.5%；III期，27.7%；IV期，51.0%），38.3%的患者有T4期肿瘤。中位生存时间为14个月（范围：0 - 56个月）。2年总生存率和无进展生存率分别为31.3%和20.4%。25例患者（53.2%）出现急性不良事件（≥3级），最常见的类型为吞咽困难、包括白细胞减少在内的血液学毒性，分别有14例（29.8%）、10例（21%）和10例（21%）患者出现发热性中性粒细胞减少。8例患者（17.0%）出现晚期不良事件（3级或更高），最常见的类型为4例患者（8.5%）发生肺炎，1例患者（2.1%；食管瘘）出现5级不良事件。多因素分析显示，中性粒细胞与淋巴细胞比值（NLR）>3（p = 0.026）与生存不良显著相关。
对于食管癌患者，60Gy的VMAT根治性放疗是可行且安全的。治疗前NLR>3是总生存期的独立预后因素。
