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胸段食管鳞癌术后局部区域复发患者放疗剂量研究
沈文斌1, 李幼梅1, 许金蕊1, 李曙光1, 宋春洋1, 赵彦1, 陈俊强2, 祝淑钗1
1河北医科大学第四医院放疗科,石家庄 050011; 2福建省肿瘤医院放疗科,福州 350014
Preliminary study of the dose of radiotherapy for patients with thoracic esophageal squamous cell carcinoma after local recurrence
Shen Wenbin1, Li Youmei1, Xu Jinrui1, Li Shuguang1, Song Chunyang1, Zhao Yan1, Chen Junqiang2, Zhu Shuchai1
1Department of Radiation Oncology, The Forth Hospital of Hebei Medical University, Shijiazhuang 050011,China; 2Department of radiotherapy, Fujian Cancer Hospital,Fuzhou 350014,China
Abstract：Objective To evaluate the effects of different irradiation doses on postoperative local recurrence in patients with esophageal cancer after radio (chemo) therapy. Methods Clinical data of 331 esophageal cancer patients presenting with postoperative local recurrence admitted to our hospital from 2009 to 2014 were collected. The recurrence site, the effects of different radiotherapy doses on the prognosis of patients and the independent prognostic factors were retrospectively analyzed. The survival rate was calculated by Kaplan-Meier method. Univariate prognostic analysis was performed by log-rank test. Multivariate prognostic analysis was conducted by Cox proportional hazard regression model. Results The 1-, 3-and 5-year overall survival rates were 54.3%,23.2% and 16.6%,respectively. The median overall survival was 13.4 months (95%CI:11.7-15.0). The median survival of patients with radiotherapy doses< 60Gy and ≥60Gy was 10.8 and 13.9 months (P=0.013). Stratified analysis showed that patients with age< 60 years, no smoking history, no drinking history, no family history, upper thoracic segment, left thoracotomy, N0 staging, log odds of positive lymph nodes (LODDS)< 0.030, recurrence time ≥ 13.1 months and recurrence site ≥ 2had better prognosis when receiving radiotherapy dose ≥ 60Gy (P=0.038, 0.033, 0.001, 0.003, 0.018, 0.010, 0.041, 0.039, 0.043 and 0.007). Moreover,the short-term clinical efficacy of patients treated with ≥60Gy dose was significantly better than that of those with<60Gy dose (P<0.001), which did not increase the incidence of ≥grade 2 radiation-induced gastritis (P=0.977) or radiation-induced pneumonitis (P=0.444). Cox multivariate analysis showed that the LODDS size, prescription dose and short-term efficacy were the independent factors affecting clinical prognosis of patients (P=0.006, 0.008 and<0.001). Conclusions The recommended dose for esophageal cancer patients with local recurrence after radiotherapy (chemotherapy) is greater than or equal to 60Gy. The results of this study need to be confirmed by prospective studies with a large sample size.
Shen Wenbin,Li Youmei,Xu Jinrui et al. Preliminary study of the dose of radiotherapy for patients with thoracic esophageal squamous cell carcinoma after local recurrence[J]. Chinese Journal of Radiation Oncology, 2021, 30(8): 780-785.
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