Reirradiation in Patients with Recurrent or Residual Esophageal Cancer after Concurrent Chemoradiotherapy or Radiotherapy

評估曾接受同步放化療或單獨放療的食道癌病患復發後再度放射治療的效果

賴姿云(Tzu-Yun Lai) ； 陳尚文(Shang-Wen Chen) ； 梁基安(Ji-An Liang) ； 簡君儒(Chun-Ru Chien) ； 王耀慶(Yao-Ching Wang) ； 楊世能(Shih-Neng Yang) ； 林振源(Chen-Yuan Lin) ； 郭于誠(Yu-Cheng Kuo)

《放射治療與腫瘤學》 21卷4期 (2014/12) Pp. 267-276

https://doi.org/10.6316/TRO/201421(4)267

摘要

目的：針對曾經接受放射線治療的食道癌病患，若有復發或殘餘腫瘤再度接受放射線治療的預後評估。材料及方法：從2007至2010年間，共38位食道鱗狀上皮細胞癌曾經接受放射線治療後復發或有殘餘腫瘤的病患進入分析，其中24位再度接受放射線治療（族群A）（18位合併化學治療，6位無合併化學治療）（放射線方法包含18位接受體外放射治療及6位接受食道腔內近接放射治療），剩餘14位（族群B）僅接受單純化學治療或支持性照顧。整體存活率為研究的初步終點，統計方法使用Kaplain-Meier方法，兩族群之間比較使用log-rank測試及coxregression來檢測差異。結果：在追蹤中位數14.4個月後（範圍在1.7到68.6個月），有29位病人死亡。整體病人存活時間的中位數是10.6 ± 1.8個月，然而在族群A存活時間的中位數是13.7 ± 2.3，族群B存活時間的中位數是4.38 ± 0.9個月(p=0.001)。在多變項分析中有接受再度放射線治療的病人也比未接受再度放射治療的病人有更長的存活時間(HR=0.30, 95% C.I. 0.10~0.89, p=0.031)。結論：我們的研究認為對於有復發或殘餘食道腫瘤的病人，再度放射治療可能是有幫助的。未來需要更多的研究去分析找出適合再度放射治療的復發食道腫瘤病人。

關鍵字

食道癌 ； 復發 ； 殘餘腫瘤 ； 再度放射治療

並列摘要

Introduction: The purpose of this study was to evaluate the treatment outcomes following reirradiation (re-RT) with or without chemotherapy in patients with recurrent or residual esophageal cancer after primary definitive concurrent chemoradiotherapy (CCRT) or radiotherapy (RT). Materials and Methods: From 2007 to 2010, 38 patients with recurrent or residual esophageal cancer who had received definitive CCRT or RT were analyzed. The pathology of all patients was squamous cell carcinoma. Among these patients, 24 received re-RT (group A). Eighteen of these patients received re-RT combined with chemotherapy and 6 received re-RT alone. External-beam radiotherapy was administered to 18 patients and intraluminal brachytherapy to 6 patients. The remaining 14 patients (group B) were treated using chemotherapy or provided supportive care. The study endpoint was to identify overall survival (OS). These rates were calculated using the Kaplan-Meier method. The log-rank test and Cox regression were performed to compare the variables. Results: After a median follow-up duration of 14.4 months (range, 1.7-68.6), 29 patients were dead. The median OS time for the entire cohort was 10.6 ± 1.8 months, whereas the OS for group A and B was 13.7 ± 2.3 months and 4.38 ± 0.9 months respectively (P=.001). According to the multivariate analysis, patients received re-RT had a longer OS than those without re-RT. (hazard ratio=0.30, 95% Confidence Interval 0.10-0.89, P=.031). Conclusion: Our study results indicate that re-RT might be feasible in patients with recurrent or residual esophageal cancer who had received previous CCRT or RT. Further studies are required to identify those who will be benefited from re-RT.

並列關鍵字

Esophageal cancer ； Relapse ； Residual tumor ； Reirradiation