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≥70岁食管癌根治性3DRT±化疗预后分析
李雪，章文成，赵路军，曹勤琛，王鹏，王平
300060 天津，国家肿瘤临床医学研究中心，天津市肿瘤防治重点实验室，天津医科大学肿瘤医院放疗科
Prognostic analysis of radical 3DRT±chemotherapy in patients with esophageal cancer aged 70 years or older
Li Xue, Zhang Wencheng, Zhao lujun, Cao Qinchen, Wang Peng, Wang Ping
Departments of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, Oncology Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center of Cancer, Tianjin 300060, China
Abstract：Objective To evaluate the efficacy and adverse effects of radical three-dimensional conformal radiotherapy (3DRT) alone or combined with chemotherapy in elderly patients (≥70 years) with esophageal cancer. Methods The clinical data of 116 esophageal cancer patients who were aged 70 years or older and received radical 3DRT±chemotherapy from 2008 to 2013 were retrospectively analyzed. Of the 116 patients, 32 received concurrent chemoradiotherapy, 24 received sequential chemoradiotherapy, and 60 received radiotherapy alone. Overall survival (OS) and progression-free survival (PFS) rates were determined using the Kaplan-Meier method, and survival difference analysis and univariate prognostic analysis was performed using the log-rank test. Multivariate prognostic analyses were performed using the Cox proportional hazard model. Results The follow-up rate was 100%. The 2-and 3-year sample sizes were 102 and 77, respectively. The 1-, 2-, and 3-year OS rates were 59.1%, 38.4%, and 23.2%, respectively, and the PFS rates were 61.9%, 37.9%, and 0%, respectively. The median OS for the patients treated with concurrent chemoradiotherapy, sequential chemoradiotherapy, and radiotherapy alone were 22.3, 18.0, and 12.4 months, respectively (P=0.044). The median OS was significantly different between patients treated with 60 Gy and<60 Gy in radiotherapy (24.7 vs. 10.9 months, P=0.036), but not significantly different between those treated with 60 Gy and>60 Gy (24.7 vs. 18.7 months, P=0.938). Multivariate analysis indicated that sex, presence or absence of combined chemotherapy, and radiotherapy dose were independent influencing factors for OS (P=0.003, 0.042, and 0.037, respectively). Conclusions Radical 3DRT±chemotherapy are well tolerated in elderly patients with esophageal cancer and equally effective as in those younger than 70 years. Patients treated with radical concurrent chemoradiotherapy have a better prognosis than those treated with sequential chemoradiotherapy and radiotherapy alone. Radiotherapy with a dose of 60 Gy effectively improves the survival compared with doses less than 60 Gy, which suggests that 60 Gy is the optimal dose in radiotherapy.
Li Xue,Zhang Wencheng,Zhao lujun et al. Prognostic analysis of radical 3DRT±chemotherapy in patients with esophageal cancer aged 70 years or older[J]. Chinese Journal of Radiation Oncology, 2015, 24(2): 111-115.
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