根治性同步放化療運用影像導航螺旋斷層或強度調控放射治療對於食道癌患者之療效－單一機構回溯性分析

DEFINITIVE CONCURRENT CHEMORADIOTHERAPY USING HELICAL TOMOTHERAPY OR INTENSITY-MODULATED RADIOTHERAPY FOR ESOPHAGEAL CANCER PATIENTS - A RETROSPECTIVE ANALYSIS AT SINGLE INSTITUTION

侯沛羽(Pei-Yu Hou) ； 謝忱希(Chen-Hsi Hsieh) ； 熊佩韋(Pei-Wei Shueng) ； 張秋涵(Chiu-Han Chang) ； 吳樂榮(Le-Jung Wu)

《放射治療與腫瘤學》 24卷2期 (2017/06) Pp. 97-106

https://doi.org/10.6316/TRO/201724(2)97

摘要

目的：回溯性分析根治性同步放化療，運用影像導航螺旋斷層放射治療，與強度調控放射治療，對食道癌病人的治療效果與副作用。材料與方法：2007至2012年間，共有67位食道癌病人接受根治性同步放化療，其中34位使用影像導航螺旋斷層放射治療，33位使用強度調控放射治療。本研究透過評估整體存活率、無疾病存活率、局部控制率與無遠端轉移存活率的治療效果，以及副作用放射性肺炎發生率、肺部及心臟的劑量分布狀況，比較不同食道癌放射治療技術之優劣。副作用的評估方法為常見不良事件評價標準第3版（CTCAE version 3.0）。結果：全部病人的追蹤時間中位數為12.1個月，整體存活時間中位數15個月。比較使用影像導航螺旋斷層與強度調控放射治療的病人，整體存活時間中位數為15個月vs. 13.4個月，1年、2年整體存活率為69% vs. 60.6%、29.8% vs. 26.7%（p = 0.48）；1年、2年無疾病存活率38.4% vs. 29.2%、21.3% vs. 16.7%（p = 0.63）；1年、2年局部控制率49.3% vs. 48.7%、32.9% vs. 39.0%（p = 0.75）；1年、2年無遠端轉移存活率76.5% vs. 61.4%、68.8% vs. 39.8%（p = 0.046）。使用影像導航螺旋斷層或強度調控放射治療對整體存活率、無疾病存活率及局部控制率並沒有顯著的差異，但影像導航螺旋斷層組病人的無遠端轉移存活率較好。比較治療劑量大於50格雷（Gy）的病人，其局部控制率和50 Gy以下的病人無顯著差異（p = 0.25）。使用影像導航螺旋斷層放射治療可降低副作用放射性肺炎的發生率（2.9% vs. 21.2%，p = 0.027），主要差異為肺部劑量分布V20：21.9% vs. 25.7%（p = 0.03）明顯較低，平均肺部劑量為14.8 Gy vs. 15.3 Gy（p = 0.47）。另外，使用影像導航螺旋斷層組的心臟劑量分布優於強度調控放射治療，V30為27.8% vs. 39.6%（p = 0.02）達到顯著差異，平均心臟劑量為22 Gy vs. 26.3 Gy（p = 0.096）。結論：單一機構回溯性分析食道癌病患接受根治性同步放化療的資料顯示，與強度調控放射治療相比，影像導航螺旋斷層放射治療的整體存活率、無疾病存活率及局部控制率可相比擬，但能減少心臟及肺部的劑量，降低放射性肺炎的發生率。

關鍵字

食道癌 ； 根治性同步放化療 ； 螺旋斷層放射治療 ； 強度調控放射治療

並列摘要

Purpose: To retrospectively review the treatment outcome of esophageal cancer in single institution, and compare the efficacy and toxicity of helical tomotherapy with step-and-shoot Intensity Modulation Radiation Therapy (IMRT). Materials and Methods: Between 2007 and 2012, 67 consecutive patients with locally advanced esophageal cancer, cT2-4N0-3M0, received definitive CCRT. The radiotherapy was delivered with helical tomotherapy in 34 patients, and with step-and-shoot IMRT in 33 patients. We evaluated the outcomes of overall survival rate (OS), disease-free survival rate (DFS), local control rate (LC), distant metastasis-free survival rate (DMFS), toxicity of radiation pneumonitis incidence, and dose distributions to lung and heart. The grading of toxicity was evaluated using CTCAE version 3.0. Result: The median follow-up was 12.1 months. The median overall survival among all patients was 15 months. The treatment outcomes between tomotherapy and step-and-shoot IMRT revealed median OS time 15 months vs. 13.4 months；1 year、2 year OS rates were 69% vs. 60.6%、29.8% vs. 26.7% (p = 0.48)；1 year、2 year DFS rates were 38.4% vs. 29.2%、21.3% vs. 16.7% (p = 0.63)；1 year、2 year LC rates were 49.3% vs. 48.7%、32.9% vs. 39.0% (p = 0.75)；1 year、2 year DMFS rates were 76.5% vs. 61.4%、68.8% vs. 39.8% (p = 0.046). No significant differences in OS, DFS, and LC rates were found between tomotherapy and IMRT. There was no significant difference in LC rate with higher radiation dose (＞ 50 Gy vs. ≦50 Gy). The patients using tomotherapy had less incidence of radiation pneumonitis (2.9%) than IMRT (21.2%；p = 0.027), and favorable dose distribution to lung with V20：21.9% vs. 25.7% (p = 0.03), and mean lung dose 14.8 Gy vs. 15.3 Gy (p = 0.47) compared with IMRT. There was also better dose distribution to heart in tomotherapy which V30 was 27.8% vs. 39.6% (p = 0.02), and mean heart dose was 22 Gy vs. 26.3 Gy (p = 0.096). Conclusion: In our retrospective analysis at single institution, CCRT using tomotherapy for esophageal cancer could reduce dose to normal organs including lung and heart, and reduce incidence of radiation pneumonitis when compared with step-and-shoot IMRT. The treatment outcomes in OS, DFS, and LC rates were similar.

並列關鍵字

Esophageal cancer ； Definitive concurrent chemoradiotherapy (CCRT) ； Helical tomotherapy ； Intensity Modulation Radiation Therapy (IMRT)