食管癌根治性调强放疗+化疗照射靶区范围对预后的影响

doi:10.3760/cma.j.cn113030-20191009-00407

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Abstract Objective To evaluate the effects of different irradiation ranges in definitive intensity-modulated radiotherapy (IMRT) combined with chemotherapy on the survival of esophageal cancer patients. Methods Clinical data of 360 esophageal cancer patients who received definitive chemoradiotherapy in the Fourth Hospital of Hebei Medical University from 2006 to 2015 were retrospectively analyzed. Among them, 131 patients received elective nodal irradiation (ENI) and 229 patients underwent involved-field irradiation (IFI). Platinum-based chemotherapy was adopted. The overall survival (OS) rate was analyzed by Kaplan-Meier method and Logrank test. Results Until the final follow-up at the end of December 2018, the follow-up rate was 96%. The median follow-up time was 64 months (95%CI:53-76). The median survival time was 24 months (95%CI:20-28). The 1-, 3-, 5-year OS rates were 76.1%, 38.7% and 21.0%, respectively. After propensity score matching, the 1-, 3-, 5-year OS rates were 83.9%, 48.6%, 26.8% vs. 74.0%, 33.8%, 17.5% between the ENI (n=131) and IFI groups (n=131)(P=0.011), respectively. Subgroup analysis showed that patients with male, aged≤66 years, cervical and upper-thoracic location, tumor length≤7cm, tumor volume≤50cm³, T1-3 stage, dosage>60Gy and concurrent chemoradiotherapy obtained better OS rates in the ENI group than their counterparts in the IFI group (all P<0.05). In the ENI group, the total failure rate, locoregional failure rate and distant metastasis rate were significantly lower, whereas the incidence of ≥Grade Ⅲ myelosuppression was remarkably higher than those in the IFI group (all P<0.05). Conclusion Compared with IFI, ENI can significantly improve the survival for patients with early-stage and cervical and upper-thoracic esophageal cancer receiving definitive IMRT combined with chemotherapy.

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	Articles by authors
	Li Qiaofang
	Deng Wenzhao
	Zhao Yan
	Song Chunyang
	Xu Jinrui
	Wang Xuan
	Zhu Shuchai

Key words： Esophageal neoplasm/Elective nodal irradiation (ENI) Involved-field irradiation (IFI) Definitive chemoradiotherapy Prognosis

Received: 09 October 2019

Corresponding Authors: Zhu Shuchai, Email:sczhu1965@163.com

Cite this article:

Li Qiaofang,Deng Wenzhao,Zhao Yan et al. Effects of different irradiation ranges in definitive intensity-modulated radiotherapy combined with chemotherapy on prognosis of patients with esophageal cancer[J]. Chinese Journal of Radiation Oncology, 2020, 29(7): 513-518.

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http://journal12.magtechjournal.com/Jweb_fszlx/EN/10.3760/cma.j.cn113030-20191009-00407 OR http://journal12.magtechjournal.com/Jweb_fszlx/EN/Y2020/V29/I7/513

[1] Siegel RL, Miller KD, Jemal A. Cancer Statistics, 2017[J]. CA Cancer J Clin, 2017, 67(1):7-30. DOI:10.7652/jdyxb201806009.
[2] Van De Voorde L, Larue RT, Pijls M, et al. A qualitative synthesisof the evidence behind elective lymph node irradiation in oesophageal cancer[J]. Radiother Oncol, 2014, 113(2):166-174. DOI:10.1016/j.radonc.2014.11.010.
[3] 董辉, 祝淑钗, 苏景伟, 等. 食管癌根治性放疗中ENI与IFI失败模式研究[J]. 中华放射肿瘤学杂志, 2014, 23(6):479-483. DOI:10.3760/cma.j.issn.1004-4221.2014.06.005.
Dong H,Zhu SC, Su JW, et al. A comparative study of failure patterns of definitive treatment of esophageal cancer with elective nodal irradiation and involved-field irradiation[J]. Chin J Radiat Oncol, 2014, 23(6):479-483. DOI:10.3760/cma.j.issn.1004-4221.2014.06.005.
[4] 祝淑钗,董辉,刘志坤,等. 早期食管癌根治性放射治疗不同照射范围的比较研究[J]. 中华放射肿瘤学杂志, 2015, 24(6):615-618. DOI:10.3760/cma.j.issn.1004-4221. 2015.06.003.
Zhu SC, Dong H, Liu ZK, et al. A comparative study of different irradiation ranges in radical radiotherapy for early stage esophageal cancer[J]. Chin J Radiat Oncol, 2015, 24(6):615-618. DOI:10.3760/cma.j.issn.10 04-4221.2015.06.003.
[5] Ma JB, Song YP, Yu JM, et al. Feasibility of involved-field conformal radiotherapy for cervical and upper-thoracic esophageal cancer[J]. Onkologie, 2011, 34(11):599-604. DOI:10.1159/000334194.
[6] Liu M, Zhao K, Chen Y, et al. Evaluation of the value of ENI in radiotherapy for cervical and upper thoracic esophageal cancer:a retrospective analysis[J]. Radiat oncol, 2014, 9(2):232. DOI:10.1186/s13014-014-0232-4.
[7] Zhu H, Pan W, Chen Y, et al. What is the optimal radiotherapy target size for non-operable esophageal cancer? A meta-analysis[J]. Oncol Res Treat, 2019, 42(9):470-479. DOI:10.1159/000501594.
[8] Du D, Song T, Liang X, et al. Concurrent chemoradiotherapy with elective lymph node irradiation for esophageal cancer:a systemic review and pooled analysis of the literature[J]. Dis Esophagus, 2017, 30(2):1-9. DOI:10.1111/dote.12471.
[9] Guan H, Yu Y, Ge H, et al. Implication of clinical target delineation for T1b/T2 thoracic esophageal squamous cell carcinoma based on the pattern of lymphy node metastases[J]. Future Oncol, 2019, 15(29):3345-3355. DOI:10.2217/fon-2019-0266.
[10] Tanaka T, Matono S, Mori N, et al. T1 squamous cell carcinoma of the esophagus:long-term outcomes and prognostic factors after esophagectomy[J]. Ann Surg Oncol, 2014, 21(3):932-938. DOI:10.1245/s10434-013-3 372-0.
[11] Cheng J, Kong L, Huang W, et al. Explore the radiotherapeutic clinical target volume delineation for thoracic esophageal squamous cell carcinoma from the pattern of lymphatic metastases[J]. J Thorac Oncol, 2013, 8(3):359-365. DOI:10.1097/JTO.0b013e31827e1f6d.
[12] Shiozaki H, Sudo K, Xiao L, et al. Distribution and timing of distant metastasis after local therapy in a large cohort of patients with esophageal and esophagogastric junction cancer[J]. Oncology, 2014, 86(5-6):336-339. DOI:10.1159/000360703.
[13] Zhang P, Xi M, Zhao L, et al. Clinical efficacy and failure pattern in patients with cervical esophageal cancer treated with definitive chemoradiotherapy[J]. Radiother Oncol, 2015, 116(2):257-261. DOI:10.1016/j. radonc.2015.07.011.
[14] 李巧芳,祝淑钗,邓文钊,等. 颈胸上段食管癌根治性放化疗靶区范围对预后生存的影响[J]. 中华放射医学与防护杂志, 2019, 39(4):268-273. DOI:10.3760/cma.j.issn.0254-50 98.2019.04.005.
Li QF, Zhu SC, Deng WZ, et al. Clinical outcomes in different target volume for cervical and upper-thoracic esophageal cancer in definitive chemoradiotherapy[J]. Chin J Radiol Med Prot, 2019, 39(4):268-273. DOI:10.3760/cma.j.issn.0254-50 98.2019.04.005.
[15] Ito M, Kodaira T, Tachibana H, et al. Clinical results of definitive chemoradiotherapy for cervical esophageal cancer:Comparison of failure pattern and toxicities between intensity-modulated radiotherapy and 3-dimensional conformal radiotherapy[J]. Head Neck, 2017, 39(12):2406-2415. DOI:10.1002/hed. 24909.
[16] Zhang JQ, Zhang WC, Zhang BZ, et al. Clinical results of intensity-modulated radiotherapy for 250 patients with cervical and upper thoracic esophageal carcinoma[J]. Cancer Manag Res, 2019, 11:8285-8294. DOI:10.2147/CMAR. S203575.