Wang Mengjiao, Yang Jian, Wang Dafei, Zhou Juying, Qin Songbing, Jiao Yang, Wang Lili
Department of Radiation Oncology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China.
Department of Radiation Oncology, Yixing Cancer Hospital, Yixing, 214200, China.
Radiat Oncol. 2025 May 15;20(1):76. doi: 10.1186/s13014-025-02661-4.
This study aimed to assess the clinical utility of deep hyperthermia in elderly patients with esophageal cancer(EC) who underwent intensity-modulated radiotherapy(IMRT).
This retrospective analysis included 177 elderly patients with EC who underwent IMRT between 2017 and 2023, 42 of whom had combined deep hyperthermia (HT). Propensity score matching (PSM) was used to balance the covariates between the thermoradiotherapy (HTRT) group and IMRT-alone groups. Treatment outcomes and toxicities were compared between the two groups. We used the Kaplan-Meier method to estimate survival curves and the log-rank test to compare survival curves. Cox multivariate analysis was performed to analyze the prognostic factors in these patients.
After PSM (42 patients in each group), the HTRT group had a greater objective response rate (ORR) than the IMRT-alone group (83% vs. 62%, P = 0.028). The HTRT group had less radiotherapy-related toxicity, including a lower incidence of leukopenia (14% vs. 33%, P = 0.040) and RP grade ≥ 2 (P = 0.012). However, the 1-, 2-, and 3-year overall survival (OS) rates and 1-, 2-, and 3-year disease-free survival (DFS) rates were not significantly different (P = 0.730, 0.964). Grade ≥ 2 hypoproteinemia (odds ratio [OR] = 3.798, P = 0.004), radiotherapy dose ≤ 60 Gy (OR = 0.445, P = 0.006), and tumor location in the lower esophagus (OR = 0.387, P = 0.005) were adverse prognostic factors for OS. Hypoproteinemia grade ≥ 2 (OR = 3.676, P < 0.001) was also a crucial prognostic factor for DFS.
Adding deep hyperthermia to IMRT can improve the ORR in elderly patients with EC. In addition, it significantly reduces radiotherapy-related toxicity. Although this approach does not improve the long-term prognosis, it is still practical and has low toxicity, making it suitable for clinical use.
本研究旨在评估深部热疗在接受调强放射治疗（IMRT）的老年食管癌（EC）患者中的临床应用价值。
本回顾性分析纳入了2017年至2023年间接受IMRT的177例老年EC患者，其中42例联合了深部热疗（HT）。采用倾向评分匹配（PSM）来平衡热放疗（HTRT）组和单纯IMRT组之间的协变量。比较两组的治疗效果和毒性反应。我们使用Kaplan-Meier方法估计生存曲线，并使用对数秩检验比较生存曲线。进行Cox多因素分析以分析这些患者的预后因素。
PSM后（每组42例患者），HTRT组的客观缓解率（ORR）高于单纯IMRT组（83%对62%，P = 0.028）。HTRT组的放疗相关毒性较小，包括白细胞减少症的发生率较低（14%对33%，P = 0.040）以及放射性肺炎（RP）≥2级的发生率较低（P = 0.012）。然而，1年、2年和3年总生存率（OS）以及1年、2年和3年无病生存率（DFS）差异无统计学意义（P = 0.730，0.964）。≥2级低蛋白血症（比值比[OR]=3.798，P = 0.004）、放疗剂量≤60 Gy（OR = 0.445，P = 0.006）以及肿瘤位于食管下段（OR = 0.387，P = 0.005）是OS的不良预后因素。≥2级低蛋白血症（OR = 3.676，P < 0.001）也是DFS的关键预后因素。
在IMRT基础上加用深部热疗可提高老年EC患者的ORR。此外，它能显著降低放疗相关毒性。虽然这种方法不能改善长期预后，但仍具有实用性且毒性低，适合临床应用。
