术后辅助3DRT改善pT2－3N0M0期食管癌患者长期生存

doi:10.3760/cma.j.issn.1004-4221.2015.02.sss

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Abstract Objective To assess the clinical value of three-dimensional conformal radiotherapy (3DRT) in postoperative adjuvant therapy after initial radical surgery for pathological T_2－3N₀M₀ thoracic esophageal squamous cell carcinoma (pT_2－3N₀M₀ TESCC). Methods The recurrence, survival, and radiotherapy adverse events in 96 patients with pT_2－3N₀M₀ TESCC who received adjuvant 3DRT after radical surgery from a prospective nonrandomized phase Ⅱ clinical study from 2004 to 2011 were compared with those in 820 patients undergoing surgery alone. The survival rate was determined by the Kaplan-Meier method and analyzed using the log-rank test. Multivariate prognostic analysis was performed using the Cox proportional hazard model. Results Postoperative 3DRT group had a significantly higher ratio of patients with tumor length ≥5 cm and stage T₃ than surgery alone group. The 5-year sample sizes for the postoperative 3DRT and surgery alone groups were 35 and 270, respectively. The 5-year overall survival (OS) and disease-free survival (DFS) rates for the postoperative 3DRT versus surgery alone group were 74.3% vs. 59.9%(P=0.010) and 71.0% vs. 51.7%(P=0.002), respectively. Multivariate analysis revealed that 3DRT was independently associated with an improved OS (P=0.030) and DFS (P=0.004). The overall recurrence rate, locoregional recurrence rate, and distant metastasis rate in the postoperative 3DRT group versus surgery alone group were 22.9% vs. 43.0%(P=0.000), 18.8% vs. 35.2%(P=0.001), and 11.5% vs. 21.3%(P=0.024), respectively. Both early and late grade 3 adverse events developed in 25 patients (26.0%) in the postoperative 3DRT group. Conclusions Compared with surgery alone, postoperative adjuvant 3DRT reduces the recurrence rate and improves the 5-year DFS and OS with tolerable adverse effects in patients with pT_2－3N₀M₀ TESCC. Prospective randomized phase Ⅲ clinical study is still needed.

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	Articles by authors
	Yang Jinsong
	Zhang Wencheng
	Xiao Zefen
	Zhou Zongmei
	Zhang Hongxing
	Chen Dongfu
	Feng Qinfu
	He Jie
	Gao Shugeng
	Sun Kelin
	Liu Xiangyang
	Fang Dekang
	Mu Jyuwei
	Wang Dali

Key words： Esophageal neoplasms/surgery Esophageal neoplasms/radiotherapy Radiotherapy,postoperative Radiotherapy,intensity-modulated Radiotherapy,three-dimensional

Received: 10 November 2014

Corresponding Authors: e Jie,Department of Thoracic Surgery,Email:prof.hejie@263.net;Xiao Zefen,Department of Radiation Oncology,Email:xiaozefen@sina.com

Cite this article:

Yang Jinsong,Zhang Wencheng,Xiao Zefen et al. Postoperative adjuvant three-dimensional conformal radiotherapy improves long-term survival in patients with pathological T_2－3N₀M₀ esophageal cancer[J]. Chinese Journal of Radiation Oncology, 2015, 24(2): 101-105.

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http://journal12.magtechjournal.com/Jweb_fszlx/EN/10.3760/cma.j.issn.1004-4221.2015.02.sss OR http://journal12.magtechjournal.com/Jweb_fszlx/EN/Y2015/V24/I2/101

[1]Chen W, Zheng R, Zhang S, et al. Annual report on status of cancer in china, 2010[J]. Chin J Cancer Res,2014,26(1):48-58. DOI:10.3978/j.issn.1000-9604.2014.01.08.
[2]Dresner SM, Griffin SM. Pattern of recurrence following radical oesophagectomy with two-field lymphadenectomy[J]. Br J Surg,2000,87(10):1426-1433.
[3]Mariette C, Balon JM, Piessen G, et al. Pattern of recurrence following complete resection of esophageal carcinoma and factors predictive of recurrent disease[J]. Cancer,2003,97(7):1616-1623.
[4]Xiao ZF, Yang ZY, Liang J, et al. Value of radiotherapy after radical surgery for esophageal carcinoma:a report of 495 patients[J]. Ann Thorac Surg,2003,75(2):331-336.
[5]Rice TW, Rusch VW, Apperson-Hansen C, et al. Worldwide esophageal cancer collaboration[J]. Dis Esophagus,2009,22(1):1-8.DOI:10.1111/j.1442-2050.2008.00901.x.
[6]Worni M, Martin J, Gloor B, et al. Does surgery improve outcomes for esophageal squamous cell carcinoma
An analysis using the surveillance epidemiology and end results registry from 1998 to 2008[J]. J Am Coll Surg,2012,215(5):643-651. DOI:10.1016/j.jamcollsurg.2012.07.006.
[7]Visbal AL, Allen MS, Miller DL, et al. Ivor lewis esophagogastrectomy for esophageal cancer[J]. Ann Thorac Surg, 2001,71(6):1803-1808.
[8]Chen J, Zhu J, Pan J, et al. Postoperative radiotherapy improved survival of poor prognostic squamous cell carcinoma esophagus[J]. Ann Thorac Surg,2010,90(2):435-442.DOI:10.1016/j.athoracsur.2010.04.002.
[9]Schreiber D, Rineer J, Vongtama D, et al. Impact of postoperative radiation after esophagectomy for esophageal cancer[J]. J Thorac Oncol,2010,5(2):244-250.DOI:10.1097/JTO.0b013e3181c5e34f.
[10]Shridhar R, Weber J, Hoffe SE, et al. Adjuvant radiation therapy and lymphadenectomy in esophageal cancer:a seer database analysis[J]. J Gastrointest Surg,2013,17(8):1339-1345.DOI:10.1007/s11605-013-2192-7.
[11]Xu Y, Liu J, Du X, et al. Prognostic impact of postoperative radiation in patients undergoing radical esophagectomy for pathologic lymph node positive esophageal cancer[J/OL]. Radiat Oncol,2013,8:116[2014-11-09].http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3671214/.DOI:10.1186/1748－717X-8-116.
[12]Ando N, Iizuka T, Kakegawa T, et al. A randomized trial of surgery with and without chemotherapy for localized squamous carcinoma of the thoracic esophagus:The japan clinical oncology group study[J]. J Thorac Cardiovasc Surg,1997,114(2):205-209.
[13]Ando N, Iizuka T, Ide H, et al. Surgery plus chemotherapy compared with surgery alone for localized squamous cell carcinoma of the thoracic esophagus:A japan clinical oncology group study—jcog9204[J]. J Clin Oncol,2003,21(24):4592-4596. DOI:10.1200/JCO.2003.12.095.
[14]Teniere P, Hay JM, Fingerhut A, et al. Postoperative radiation therapy does not increase survival after curative resection for squamous cell carcinoma of the middle and lower esophagus as shown by a multicenter controlled trial. French university association for surgical research[J]. Surg Gynecol Obstet,1991,173(2):123-130.
[15]Zieren HU, Muller JM, Jacobi CA, et al. Adjuvant postoperative radiation therapy after curative resection of squamous cell carcinoma of the thoracic esophagus:a prospective randomized study[J]. World J Surg,1995,19(3):444-449.
[16]Fok M, Sham JS, Choy D, et al. Postoperative radiotherapy for carcinoma of the esophagus:a prospective, randomized controlled study[J]. Surgery,1993,113(2):138-147.
[17]Chapet O, Kong FM, Quint LE, et al. Ct-based definition of thoracic lymph node stations:An atlas from the university of michigan[J]. Int J Radiat Oncol Biol Phys,2005,63(1):170-178. DOI:10.1016/j.ijrobp.2004.12.060.
[18]Martin JT, Worni M, Zwischenberger JB, et al. The role of radiation therapy in resected t2 n0 esophageal cancer:a population-based analysis[J]. Ann Thorac Surg,2013,95(2):453-458.DOI:10.1016/j.athoracsur.2012.08.049.
[19]肖泽芬,章众,张红志,等.用三维治疗计划系统评估食管癌常规放射治疗中肿瘤剂量的分布[J].中华放射肿瘤学杂志,2004,13(4):273-277.
[20]Lai SZ, Li WF, Chen L, et al. How does intensity-modulated radiotherapy versus conventional two-dimensional radiotherapy influence the treatment results in nasopharyngeal carcinoma patients?[J].Int J Radiat Oncol Biol Phys,2011,80(3):661-668.DOI:10.1016/j.ijrobp.2010.03.024.
[21]Sher DJ, Koshy M, Liptay MJ, et al. Influence of conformal radiotherapy technique on survival after chemoradiotherapy for patients with stage iii non-small cell lung cancer in the national cancer data base[J]. Cancer,2014,120(13):2060-2068.DOI:10.1002/cncr.28677.