放疗剂量对颈段食管鳞癌根治性同步放化疗预后的影响

Effect of radiotherapy dose on prognosis of cervical esophageal squamous cell carcinoma after define concurrent chemoradiotherapy

目的颈段食管鳞癌(CEC)的根治性放疗剂量存在争议,本研究对接受根治性同步放化疗的CEC患者的疗效进行分析,以期为CEC的放疗剂量提供临床参考。方法回顾性分析2013年1月—2021年12月蚌埠医科大学第一附属医院放疗科收治的89例接受调强放疗的颈段食管鳞癌患者资料,根据放疗剂量分成2组,分别为低剂量组(EQD2Gy≤60 Gy,26例)及高剂量组(EQD2Gy>60 Gy,63例)。化疗方案包括以铂类为基础的双药联合和单纯口服替吉奥胶囊。采用Kaplan-Meier法计算局部区域控制(LRC)、无进展生存(PFS)、总生存(OS),log-rank法进行差异性检验及单因素分析,Cox模型分析独立预后因素。结果随访至2022年12月底,随访率为100%,中位随访时间为100个月,1、3、5年LRC率分别为76.1%、37.9%、22.4%,PFS率分别为67.4%、30.0%、16.2%,OS率分别为85.4%、47.1%、29.6%。单因素分析显示T分期、N分期、TNM分期和放疗剂量是OS、PFS、LRC的影响因素,多因素分析显示放疗剂量是颈段食管鳞癌0S、PFS、LRC的独立预后因素(P<0.05)。结论颈段食管鳞癌采用根治性放化疗时,EQD2Gy>60 Gy显示出更好的生存获益,放疗剂量是OS、PFS、LRC的独立预后因素。

Objective The dose of define concurrent chemoradiotherapy for cervical esophageal squamous cell carcinoma(CEC)is controversial.This study analyzed the efficacy of patients with CEC who received define concurrent chemora-diotherapy,hoping to provide a clinical reference for the dose of radiotherapy for CEC.Methods A retrospective analy-sis was performed on 89 patients with CEC who received intensity-modulated radiotherapy(IMRT)in the Department of Radiotherapy,the First Affiliated Hospital of Bengbu Medical University from January 2013 to December 2021 and were divided into two groups according to radiotherapy dose:a low-dose group(EQD2Gy≤60 Gy)and a high-dose group(EQD2Gy>60 Gy).Chemotherapy regimens include platinum-based dual drug combination or S1 alone.The Kaplan-Meier method was used to calculate loco-regional control(LRC),progression-free survival(PFS),and overall survival(OS).The log-rank method was used to test differences and univariate analysis.The Cox model was used to analyze prognostic factors.Results The follow-up rate was 100%and the median follow-up time was 100 months.The 1-year,3-year,and 5-year LRC rates were 76.1%,37.9%,and 22.4%,respectively,and the PFS rates were 67.4%,30.0%,and 16.2%,respectively.The OS rates were 85.4%,47.1%,and 29.6%,respectively.Univariate analysis showed that T stage,N stage,TNM stage,and radiotherapy dose were the influencing factors of OS,PFS,and LRC,and radiotherapy dose was the independent prognostic factor of 0S,PFS,and LRC in cervical esophageal squamous cell carci-noma(P<0.05).Conclusion When cervical esophageal squamous cell carcinoma is treated with define chemoradio-therapy,EQD2Gy>60 Gy showed a better survival benefit,and radiotherapy dose was an independent prognostic factor for OS,PFS,and LRC.