同步增量调强放疗联合化疗治疗食管鳞癌疗效评估

Long-term efficacy evaluation of simultaneous integrated boost intensity-modulated radiotherapy combined with chemotherapy for esophageal squamous cell carcinoma

目的探讨同步加量调强放疗(SIB-IMRT)联合多西他赛顺铂(DP)治疗颈段和胸中上段食管癌疗效,并评估其可行性。方法选择2009-05-01-2012-07-31山东省肿瘤医院行放化疗治疗的食管癌患者23例,其中肿瘤位于颈段3例,胸上段13例,胸中段7例;肿瘤长度2.5~10 cm,中位长度5.5 cm。放疗采用SIB-IMRT(PTV-G 60.2 Gy/28次;PTV-C 50.4 Gy/28次),放疗同时联合DP方案化疗,共完成2个周期。生存分期采用Kaplan-meier曲线描述,并行Log-rank检验。影响生存单因素分析采用Cox回归。结果23例患者均坚持至同步放化疗结束。Ⅲ/Ⅳ度骨髓抑制发生率34.8%(8/23),Ⅲ/Ⅳ度急性放射性食管炎发生率30.4%(7/23)。1年内3例出现食管瘘。近期疗效评估:完全缓解(CR)7例(30.4%),部分缓解(PR)9例(39.1%),疾病稳定(SD)5例(21.7%),疾病进展(PD)2例(8.7%),近期疾病控制率91.3%(21/23)。中位生存时间30个月,1、2、3和5年总生存率(OS)分别为78%、57%、35%和25%。根据近期疗效的不同进一步对比OS,CR患者具有更好的生存情况(χ^(2)=11.641,P=0.009)。多因素分析显示,病变位置(HR=0.367,95%CI为0.157~0.859,P=0.021)及近期疗效(HR=3.401,95%CI为1.797~6.436,P<0.001)与生存相关,胸段食管癌预后好于颈段食管癌,近期疗效好的患者OS更高。结论SIB-IMRT联合DP方案化疗治疗颈段和胸中上段食管鳞癌,近期疗效CR患者具有更好的生存情况。急性毒副作用主要表现为血液学毒性和放射性食管炎,但食管瘘发生率较高,因此具体的分割模式和病例的选择需进一步探讨。

Objective To explore the efficacy and feasibility of simultaneous intensity-modulated radiotherapy combined with DP chemotherapy in the treatment of esophageal cancer of the cervical and upper two thirds of thoracic segments.Methods Twenty-three patients with esophageal cancer who were treated with concurrent chemoradiotherapy at Shandong Cancer Hospital from May 1 st 2009 to July 31 st 2012 were selected.The tumors of 3 cases were located in the cervical esophagus,13 cases in the upper thoracic esophagus and 7 cases in the middle thoracic esophagus.The length of the tumor range from 2.5 cm to 10 cm with a median length of 5.5 cm.Radiotherapy was performed with simultaneous integrated boost intensity-modulated radiotherapy(PTV-G 60.2 Gy/28 fractions,PTV-C 50.4 Gy/28 fractions).At the same time,two courses of chemotherapy with the reagents of DP(Docetaxel+Cisplatin)were used concurrent with radiotherapy.Results All 23 patients persisted until the end of concurrent chemoradiotherapy.The incidence of gradeⅢ/Ⅳhematological toxicity was 34.8%(8/23),and the incidence of gradeⅢ/Ⅳacute radiation esophagitis was 30.4%(7/23).Esophageal fistula occurred in 3 cases within 1 year.Short-term efficacy evaluation:CR in 7 cases(30.4%),PR in 9 cases(39.1%),SD in 5 cases(21.7%),PD in 2 cases(8.7%),and recent disease control rate was 91.3%(21/23).The median survival time was 30 months.The overall survival rates at 1 year,2 years,3 years,and 5 years were 78%,57%,35%and25%,respectively.Further comparison of survival rates according to the short-term efficacy showed that patients with CR had better survival(Log-rank test P=0.009).Conclusions Simultaneous integrated boost IMRT combined with DP chemotherapy for esophageal squamous cell carcinoma is effective.Patients of CR have better survival.Acute toxic side effects are mainly manifested in hematological toxicity and esophagitis.There was a high incidence of esophageal fistula.Therefore,the specific dose fraction mode and case selection need to be further explored.