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胸段食管鳞癌根治性同步放化疗不同放疗剂量近远期疗效及不良反应分析

Analysis of short-term and long-term efficacy and adverse reactions of different radiotherapy doses of radical synchronous radiotherapy and chemotherapy for thoracic esophageal squamous cell carcinoma
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摘要 目的探讨胸段食管鳞癌根治性同步放化疗不同放疗剂量近远期疗效以及不良反应,以期寻找食管癌放化疗最佳的放疗剂量模式。方法回顾性分析2014年1月至2017年6月于新疆巴州人民医院和河北医科大学第四医院接受同步放化疗的158例胸段食管鳞癌患者的临床资料,其中男性95例、女性63例,年龄(57.2±7.4)岁。按不同放疗剂量将所有患者分为高剂量放疗组(55.0~60.0 Gy)75例和低剂量放疗组(50.4~55.0 Gy)83例。采用1∶1倾向性评分匹配(PSM)法将2组中倾向性评分最相近的患者进行配对,比较匹配前后2组患者各临床资料的差异,治疗前后血清T淋巴细胞亚群表达水平的变化,近期疗效以及不良反应发生率。2组间的比较采用两独立样本t检验和χ^(2)检验。采用Kaplan-Meier生存分析比较匹配后2组患者同步放化疗后的疾病无进展生存率和总生存率。结果PSM前2组患者的年龄、肿瘤最大径、T分期以及N分期的差异均有统计学意义(t=1.589、4.322,χ^(2)=4.789、5.112,均P<0.05)。2组共46对患者成功配对,PSM后2组患者各临床资料的比较,差异均无统计学意义(t=0.196~0.624,χ^(2)=0.386~0.517,均P>0.05)。PSM后高剂量放疗组客观缓解率明显高于低剂量放疗组[65.2%(30/46)对32.6%(15/46)],且差异有统计学意义(χ^(2)=5.144,P=0.032)。PSM后低剂量放疗组患者治疗后血清CD4+、CD4+/CD8+比值的水平高于高剂量放疗组,血清CD8+水平低于高剂量放疗组,但差异均无统计学意义(t=1.145~1.389,均P>0.05)。低剂量放疗组患者的3~4级放射性食管炎、放射性肺炎、骨髓抑制、胃肠道反应的发生率显著低于高剂量放疗组[15.2%(7/46)对56.5%(26/46)、26.1%(12/46)对60.9%(28/46)、30.4%(14/46)对65.2%(30/46)、34.8%(16/46)对73.9%(34/46)],且差异均有统计学意义(χ^(2)=4.356~5.923,均P<0.05)。PSM后高剂量放疗组患者同步放化疗后5年无疾病进展生存率和总生存率显著高于低剂量放疗组[37.0%(17/46)对17.4%(8/46),73.9%(34/46)对52.2%(24/46)],且差异均有统计学意义(χ^(2)=4.449、4.665,均P<0.05)。结论相比50.4 Gy低剂量放疗模式,高剂量放疗能显著提高胸段食管鳞癌患者根治性同步放化疗的肿瘤局部控制率,提高患者的疾病无进展生存率和总生存率,但也一定程度地增加了治疗相关的不良反应。 Objective To explore the short-and long-term therapeutic efficacy and adverse reactions caused by various radiotherapy doses in radical synchronous radiotherapy and chemotherapy of thoracic esophageal squamous cell carcinoma to find the optimal radiotherapy dose pattern for esophageal cancer chemoradiotherapy.Methods A retrospective analysis was conducted on the clinical data of 158 patients with thoracic esophageal squamous cell carcinoma who received radical synchronous radiotherapy and chemotherapy from January 2014 to June 2017 in the Xinjiang Bazhou People's Hospital and the Fourth Hospital of Hebei Medical University.The patients comprised 95 males and 63 females,aged(57.2±7.4)years,and were divided into high-(55.0 to 60.0 Gy)with 75 cases and low-dose(50.4 to 55.0 Gy)with 83 cases radiotherapy groups based on various radiotherapy doses.The patients were matched with the closest propensity scores in the two groups via a 1∶1 propensity score matching(PSM)method.Comparisons were conducted on the differences in various clinical data before and after matching,changes in the expression levels of serum T lymphocyte subsets before and after treatment,short-term efficacy,and the incidence of adverse reactions.Between-groups comparisons were performed using two independent-sample t-tests andχ^(2)tests.Kaplan-Meier survival analysis was conducted to compare the progression-free survival rate and overall survival rate of the matched groups after radical synchronous radiotherapy and chemotherapy.Results The age,maximum tumor diameter,T stage,and N stage of the two groups before PSM method matching were compared,and the differences showed statistical significance(t=1.589,4.322,χ^(2)=4.789,5.112;all P<0.05).A total of 46 pairs of patients were successfully matched in the two groups.After PSM method matching,the clinical data between the two groups of patients were compared,and the results indicated no statistically significant differences(t=0.196−0.624,χ^(2)=0.386−0.517;all P>0.05).The high-dose radiotherapy group exhibited a significantly higher objective response rate than the low-dose radiotherapy group(65.2%(30/46)vs.32.6%(15/46)),and the difference was statistically significant(χ^(2)=5.144,P=0.032).After treatment,the low-dose radiotherapy group showed higher serum CD4+and ratio of CD4+/CD8+levels than the high-dose radiotherapy group and a lower serum CD8+level.However,these differences were not statistically significant(t=1.145−1.389;all P>0.05).The low-dose radiotherapy group attained significantly lower incidences of grade 3−4 radiation esophagitis,radiation pneumonitis,bone marrow suppression,and gastrointestinal reactions than the high-dose radiotherapy group(15.2%(7/46)vs.56.5%(26/46),26.1%(12/46)vs.60.9%(28/46),30.4%(14/46)vs.65.2%(30/46),34.8%(16/46)vs.73.9%(34/46)),the differences were statistically significant(χ^(2)=4.356−5.923,all P<0.05).The high-dose radiotherapy group presented a significantly higher 5-year progression-free survival rate and overall survival rate after radical synchronous radiotherapy and chemotherapy compared with the low-dose radiotherapy group(37.0%(17/46)vs.17.4%(8/46),73.9%(34/46)vs.52.2%(24/46)),and the differences were statistically significant(χ^(2)=4.449,4.665;both P<0.05).Conclusions Compared with the low dose radiotherapy pattern of 50.4 Gy,high-dose radiotherapy can considerably improve the local tumor control rate in patients with thoracic esophageal squamous cell carcinoma undergoing radical synchronous radiotherapy and chemotherapy and improve the progression-free rate and overall survival rate.However,such procedure can also increase treatment-related adverse reactions to some extent.
作者 段有升 张丽娜 沈文斌 Duan Yousheng;Zhang Lina;Shen Wenbin(Department of Radiotherapy,Xinjiang Bazhou People's Hospital,Korla 841000,China;Department of Laboratory,Xinjiang Bazhou People's Hospital,Korla 841000,China;Department of Radiotherapy,the Fourth Hospital of Hebei Medical University,Shijiazhuang 050011,China)
出处 《国际放射医学核医学杂志》 2024年第6期351-358,共8页 International Journal of Radiation Medicine and Nuclear Medicine
基金 省部共建中亚高发病成因与防治国家重点实验室开放课题(SKL-HIDCA-2020-39)。
关键词 食管肿瘤 化放疗 放射治疗剂量 Esophageal neoplasms Chemoradiotherapy Radiotherapy dosage
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