Objective To analyze the survival of patients with esophageal squamous cell carcinoma (ESCC) treated by different regimens and different radiation doses and to explore the optimal radiation dose and subgroups with potential clinical benefit. Methods A total of 1387 patients with ESCC who received conformal radiotherapy or intensity-modulated radiotherapy in our hospital from July 2003 to March 2014 were enrolled in this retrospective study. The patients who received different radiation doses in radiotherapy alone or in concurrent chemoradiotherapy were analyzed. The log-rank test and Cox regression analysis were used to explore the optimal radiation dose and the benefited subgroups. Resutls A total of 780 patients only received radiotherapy. Among them,the median survival of patients receiving radiation dose<60 Gy (n=91),60 Gy (n=429),and>60 Gy (n=260) was 9,20,and 23 months,respectively,suggesting a significant difference (P=0.000).The patients with a radiation dose of 60 Gy had a similar survival curve to the patients with radiation dose>60 Gy,both significantly higher than that in patients with radiation dose<60 Gy (P=0.000,0.000).Totally 302 patients received concurrent chemoradiotherapy. Among them,the median survival of patients receiving radiation dose<60 Gy (n=18),60 Gy (n=224),and>60 Gy (n=60) was 22,34,and 15 months,respectively,suggesting a significant difference (P=0.004).The survival curve showed no significant difference between the patients with radiation dose<60 Gy and>60 Gy (P=0.952),while the patients with a radiation dose of 60 Gy had a better survival compared with the patients with radiation dose<60 Gy or>60 Gy. The Cox multivariate regression analysis indicated that the ESCC patients receiving radiotherapy alone or concurrent chemoradiotherapy had different prognosis;gross tumor volume (GTV) and radiation dose were two independent prognostic factors in the same treatment model (P=0.045,0.001).In radiotherapy alone,radiation dose ≥60 Gy was a protective factor for the patients’ survival (P=0.000).In concurrent chemoradiotherapy,a radiation dose of 60 Gy was a protective factor,while radiation dose<60 Gy or>60 Gy presented no survival benefit (P=0.051). Conclutions The optimal radiation dose is no less than 60 Gy in ESCC patients treated by radiotherapy alone. If the patients receive concurrent chemoradiotherapy,the radiation dose of 60 Gy is recommended.
Wang Lan,Zhen Shuman,Han Chun et al. Optimal radiation dose for esophageal squamous cell carcinoma[J]. Chinese Journal of Radiation Oncology, 2017, 26(11): 1263-1268.
[1] Cooper JS,Guo MD,Herskovic A,et al. Chemoradiotherapy of locally advanced esophageal cancer:long-term follow-up of a prospective randomized trial (RTOG 85-01).Radiation Therapy Oncology Group[J].JAMA,1999,281(17):1623-1627.
[2] Minsky BD,Pajak TF,Ginsberg RJ,et al. INT 0123(Radiation Therapy Oncology Group 94-05) phase Ⅲ trial of combined-modality therapy for esophageal cancer:high-dose versus standard-dose radiation therapy[J].J Clin Oncol,2002,20(5):1167-1174.DOI:10.1200/JCO.2002.20.5.1167.
[3] 万钧,刘明,韩春,等.食管癌放疗剂量研究的十年结果[J].中华放射肿瘤学杂志,1996,5(3):200-201.
Wan J,Liu M,Han C,et al. Results of radiotherapy for esophageal cancer for ten years[J].Chin J Radiat Oncol,1996,5(3):200-201.
[4] 韩春,杨香然,王军,等.食管癌后程加速超分割照射剂量学研究[J].中华放射肿瘤学杂志,2005,14(5):398-400.DOI:10.3760/j.issn:1004-4221.2005.05.005.
Han C,Yang XR,Wang J,et al. Esophageal cancer late course accelerated hyperfractionation radiotherapy dosimetry study[J].Chin J Radit Oncol,2005,14(5):398-400.DOI:10.3760/j.issn:1004-4221.2005.05.005.
[5] 王澜,高超,李晓宁,等.食管癌三维适形后程加速放疗的临床研究[J].中华放射肿瘤学杂志,2010,19(1):14-17.DOI:10.3760/cma.j.issn.1004-4221.2010.01.006.
Wang L,Gao C,Li XN,et al. Esophageal cancer clinical study of three dimensional conformal radiotherapy late course accelerated[J].Chin J Radit Oncol,2010,19(1):14-17.DOI:10.3760/cma.j.issn.1004-4221.2010.01.006.
[6] 中国非手术治疗食管癌临床分期专家小组.非手术治疗食管癌的临床分期标准(草案)[J].中华放射肿瘤学杂志,2010,19(3):179-180.DOI:10.3760/cma.j.issn.1004-4221.2010.03.001.Chinese non surgical treatment of clinical staging of esophageal cancer expert group[J].Chin J Radiat Oncol,2010,19(3):179-180.DOI:10.3760/cma.j.issn.1004-4221.2010.03.001.
[7] 王澜,高超,李晓宁,等.100例食管癌三维适形放疗疗效分析[J].中华放射肿瘤学杂志,2009,36(5):375-378.DOI:10.3760/cma.j.issn.1004-4221.2009.05.375.
Wang L,Gao C,Li XN,et al.100 cases of esophageal carcinoma treated by three-dimensional conformal radiotherapy curative effect analysis[J].Chin J Radiat Oncol,2009,36(5):375-378.DOI:10.3760/cma.j.issn.1004-4221.2009.05.375.
[8] 韩春,王澜,祝淑钗,等.非手术治疗食管癌临床分期标准对225例放疗患者的预后评价[J].中华放射肿瘤学杂志,2011,20(2):109-112.DOI:10.3760/cma.j.issn.1004-4221.2011.02.008.
Han C,Wang L,Zhu SC,et al. Prognostic evaluation of clinical staging criteria for non-surgical treatment of esophageal cancer in 225 patients with radiotherapy[J].Chin J Radiat Oncol,2011,20(2):109-112.DOI:10.3760/cma.j.issn.1004-4221.2011.02.008.
[9] 李辉.食管癌术前分期的现状及进展[J].中华胸心血管外科杂志,2003,19(1):1-3.DOI:10.3760/cma.j.issn.1001-4497.2003.01.001.
Li H.Current status and progress of preoperative staging of esophageal carcinoma[J].Chin J Thora Cardiovascul Surg,2003,19(1):1-3.DOI:10.3760/cma.j.issn.1001-4497.2003.01.001.
[10] 顾雅佳,王玖华,相加庆,等.CT观察胸段食管癌气管食管沟淋巴结转移的临床意义探讨[J].中华放射学杂志,2002,36(2):139-141.DOI:10.3760/j.issn:1005-1201.2002.02.014.
[11] Overhagen H,Lameris JS,Berger MY,et al. Supraclavicular lymph node metastases in carcinoma of the esophageal and gastroesophageal junction:assessment with CT,US and US-guided fine-needle aspiration biopsy[J].Radiology,1991,179(1):155-158.DOI:10.1148/radiology.179.1.2006268.
[12] Takashi M,Yasumasa N,Yutaka S,et al. Optimal size criteria of malignant lymph nodes in the treatment planning of radiotherapy for esophageal cancer:evaluation by computed tomography and magnetic resonance imaging[J].Int J Radiat Oncol Biol Phys,1996,36(5):1091-1098.
2017, Vol. 26 
