Comparison of survival benefits between simultaneous integrated boost intensity-modulated radiotherapy and conventional fractionated radiotherapy for esophageal squamous cell carcinoma
Wang Lan, Liang Jian, Han Chun, Xu Li′ang, Liu Lihong, Ren Xuejiao, Liu Shutang, Zhen Shuman, Ding Boyue
Department of Radiation Oncology,Fourth Hospital of Hebei Medical University,Shijiazhung 050011,China (Wang L,Han C,Xu LA,Liu LH,Ren XJ,Liu ST,Zhen SM,Ding BY) ;
Medical Department,Heibei Chest Hospital,Shijiazhuang 050041,China (Liang J)
Objective To investigate the survival benefits of simultaneous integrated boost intensity-modulated radiotherapy (SIB-IMRT) in the treatment of esophageal squamous cell carcinoma (ESCC). Methods From July 2003 to March 2014,1748 patients with ESCC received 3DCRT or IMRT in a single institution were enrolled in this retrospective study. Among them,809 patients received conventional fractionated radiotherapy with the standard prescription dose and 110 patients received SIB-IMRT (SIB-IMRT group).Survival analysis was performed and propensity score matching (PSM 1vs1) was conducted to evaluate and compare the survival benefits between SIB-IMRT and conventional fractionated radiotherapy. Results The baseline characteristics significantly differed between two groups. In the SIB group,the age was significantly younger (64 years vs. 66 years,P=0.001),the percentage of patients with cervical/upper thoracic tumors was considerably higher (53.6% vs. 31.0%,P=0.000) and the proportion of N2 patients was significantly higher (21.8% vs. 13.7%,P=0.027) compared with those in the other group. According to the PSM of 1:1,218 patients were successfully matched. After matching,the clinical data did not significantly differ between two groups. Prior to matching,the median survival time in the standard dose and SIB-IMRT groups were 23 and 21 months (P=0.638).After matching,the median survival time in the SIB-IMRT group was 22 months,significantly longer than 18 months in the standard dose group (P=0.000).Subgroup analysis demonstrated that patients with large tumors (GTV volume>40 cm3) and middle/lower thoracic tumors obtained more survival benefits from SIB-IMRT.The median survival time of patients in the standard dose group was 14 months,significantly shorter than 21 months in the SIB-IMRT group (P=0.001).The median survival time of patients with middle/lower thoracic tumors in the SIB-IMRT group was 17 months,significantly longer than 9 months in the standard dose group (P=0.000).Multivariate analysis using Cox regression model indicated that age,tumor site and radiotherapy modality were the independent prognostic factors. The HR of SIB-IMRT was 0.551(P=0.000),which was a factor for survival benefits. Conclusions SIB-IMRT possesses potential survival benefits for ESCC compared with conventional fractionated radiotherapy. Patients with large tumors and middle/lower thoracic tumors are more prone to obtaining benefits from SIB-IMRT than their counterparts.
Wang Lan,Liang Jian,Han Chun et al. Comparison of survival benefits between simultaneous integrated boost intensity-modulated radiotherapy and conventional fractionated radiotherapy for esophageal squamous cell carcinoma[J]. Chinese Journal of Radiation Oncology, 2018, 27(11): 965-970.
[1] Franceschini D,Paiar F,Meattini I,et al. Simultaneous integrated boost-intensity modulated radiotherapy in head and neck cancer[J].Laryngoscope,2013,123(12):E97-E103.DOI:10.1002/lary.24257.
[2] Jin X,Yi J,Zhou Y,et al. A new plan quality index for nasopharyngeal cancer SIB IMRT[J].Phys Med,2014,30(1):122-127. DOI:10.1016/j.ejmp.2013.03.007.
[3] Leclerc M,Maingon P,Hamoir M,et al. A dose escalation study with intensity modulated radiation therapy (IMRT) in T2N0,T2N1,T3N0 squamous cell carcinomas (SCC) of the oropharynx,larynx and hypopharynx using a simultaneous integrated boost (SIB) approach[J].Radiother Oncol,2013,106(3):333-340.DOI:10.1016/j.radonc.2013.03.002.
[4] Yi J,Huang X,Gao L,et al. Intensity-modulated radiotherapy with simultaneous integrated boost for locoregionally advanced nasopharyngeal carcinoma[J].Radiat Oncol,2014(9):56. DOI:10.1186/1748-717X-9-56.
[5] Franco P,Arcadipane F,Ragona R,et al. Locally advanced (T3-T4 or N) anal cancer treated with simultaneous integrated boost radiotherapy and concurrent chemotherapy[J].Anticancer Res,2016,36(4):2027-2032.
[6] Tomasoa NB,Meulendijks D,Nijkamp J,et al. Clinical outcome in patients treated with simultaneous integrated boost-intensity modulated radiation therapy (SIB-IMRT) with and without concurrent chemotherapy for squamous cell carcinoma of the anal canal[J].Acta Oncol,2016,55(6):760-766.DOI:10.3109/0284186X.2015.1124141.
[7] McCammon R,Rusthoven KE,Kavanagh B,et al. Toxicity assessment of pelvic intensity-modulated radiotherapy with hypofractionated simultaneous integrated boost to prostate for intermediate-and high-risk prostate cancer[J].Int J Radiat Oncol Biol Phys,2009,75(2):413-420.DOI:10.1016/j.ijrobp.2008.10.050.
[8] Hakariya T,Obata S,Igawa T,et al. Feasibility of simultaneous integrated boost IMRT (SIB-IMRT) for castrationresistant prostate cancer[J].Anticancer Res,2014,34(8):4261-4265.
[9] Yu WW,Zhu ZF,Fu XL,et al. Simultaneous integrated boost intensity modulated radiotherapy in esophageal carcinoma:early results of a phase Ⅱ study[J].Strahlenther Onkol, 2014,190(11):979-986.DOI:10.1007/s00066-014-0636-y.
[10] 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 clinical staging group for esophageal carcinoma. Non-surgical clinical staging criterion of esophageal carcinoma (protocol)[J].Chin J Radiat Oncol,2010,19(3):179-180.DOI:10.3760/cma.j.issn.1004-4221.2010.03.001.
[11] 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. Treatment outcomes of three-dimensional conformal radiotherapy for esophageal carcinoma[J].Chin J Radiat Oncol,2009,36(5):375-378.DOI:10.3760/cma.j.issn.1004-4221.2009.05.375.
[12] 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. Evaluation of prognosis of clinical staging for esophageal carcinoma treated with non-surgical methods-addition with analysis of 225 patients[J].Chin J Radiat Oncol,2011,20(2):109-112.DOI:10.3760/cma.j.issn.1004-4221.2011.02.008.
[13] 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. The status and development of pre-operation staging for esophageal carcinoma[J].Chin J Thorac Cardiov asc Surg,2003,19(1):1-3.DOI:10.3760/cma.j.issn.1001-4497.2003.01.001.
[14] 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.
Gu YJ,Wang JH,Xiang JQ,et al. A stugy on value of CT features of tracheoesophageal groove lymph node metastasis of thoracic esophageal carcinoma[J].Chin J Radiol,2002,36(2):139-141.DOI:10.3760/j.issn:1005-1201.2002.02.014.
[15] 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.
[16] 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].Radiother Oncol,1996,36(5):1091-1098.
[17] Fu WH,Wang LH,Zhou ZM,et al. Comparison of conformal and intensity-modulated techniques for simultaneous integrated boost radiotherapy of upper esophageal carcinoma[J].World J Gastroenterol,2004,10(8):1098-1102.
[18] Welsh J,Palmer MB,Ajani JA,et al. Esophageal cancer dose escalation using a simultaneous integrated boost technique[J].Int J Radiat Oncol Biol Phys,2012,82(1):468-474.DOI:10.1016/j.ijrobp.2010.10.023.
[19] 白文文,宋玉芝,刘明,等.SIB-IMRT技术在颈及胸上段食管癌中的临床应用[J].中华肿瘤防治杂志,2016,23(4):248-252.DOI:10.16073/j.cnki.cjcpt.2016.04.010.
Bai WW, Song YZ,Liu M,et al. Clinical application of simultaneous integrated boost intensity-modulated radiation therapy in cervical and upper esophageal carcinoma[J].Chin J Cancer Prev Treat,2016,23(4):248-252. DOI:10.16073/j.cnki.cjcpt.2016.04.010.
2018, Vol. 27 
