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Definitive Concurrent Chemoradiotherapy in Esophageal Squamous Cell Carcinoma: High Dose versus Standard Dose Radiation Therapy

同步放化療用於食道鱗狀細胞癌之治療結果與放射劑量分析

摘要


目的:回溯性分析同步放化療用於食道鱗狀細胞癌及比較不同放射劑量之治療結果。材料與方法:本研究包括2007年1月至2010年12月於本院診斷為食道鱗狀細胞癌的109例患者,臨床分期T2-4、N0-1、M0-1、II-IV期無法以手術切除的食道癌病患均接受同步放化療為主要治療方法,放射治療為每次1.8-2.0 Gy,同步化學治療為靜脈滴注cisplatin為主的配方1至2個週期,放射治療技術使用三度空間順形放射治療或強度調控放射治療,所有病患接受放療劑量之中位數為56 Gy(範圍為45-70 Gy),分別比較高劑量組(56至70 Gy,55例)及標準劑量組(45至55.8 Gy,54例)病患的整體存活率及無局部復發存活率。存活率曲線以Kaplan-Meier及Cox regression法計算。結果:高劑量組和標準劑量組之兩年整體存活率分別為38.0%和23.2%。臨床分期第II,III,IV期之兩年整體存活率分別為57.9%、32.8%、20.1%。單變項分析顯示高劑量放療(≧56 Gy)、T分期、M分期及臨床期別顯著影響整體存活率(p=0.013,0.016,0.012,0.010)。多變項分析發現高劑量放療(≧56 Gy)與臨床II-III期為具影響力的較佳整體存活率預後因子(p=0.030,0.015)。在49例無遠端轉移病患之單變項及多變項分析中,高劑量放療仍為無局部復發存活率的重要預後因子(p=0.020,p=0.003)。結論:本研究顯示較高的放療劑量(≧56 Gy)用於接受同步放化療之食道鱗狀細胞癌病患可顯著改善整體存活率及無局部復發存活率。未來需要進一步的隨機臨床研究以確認使用順行放射治療技術給予較高放療劑量後之療效與影響。

並列摘要


Purpose: To analyze the treatment results and compare overall survival rate after definitive concurrent chemoradiotherapy (CCRT) with different doses of radiotherapy for esophageal squamous cell carcinoma (ESCC) in a retrospective study. Materials and Methods: This study included 109 patients with histologically confirmed ESCC at Taipei Veterans General Hospital between January 2007 and December 2010. The median age at diagnosis of the patients was 62 years old (range, 34-89 years). Patients who were clinically staged as T2-4, N0-1, M0-1, stage II-IV ESCC received definitive CCRT as the primary treatment, with radiotherapy at 1.8-2.0 Gy per fraction and concurrent infusional cisplatin-based chemotherapy for 1-2 cycles. Radiotherapy was delivered by three-dimensional conformal radiation therapy (3DCRT) or intensity modulated radiation therapy (IMRT) technique, with a median dose of 56 Gy (range, 45-70 Gy). The overall survival (OS) rates and local recurrence free survival (LRFS) rates were compared between high radiation dose (56-70 Gy, n= 55) group and standard radiation dose (45-55.8 Gy, n= 54) group. Survival analysis was done with the Kaplan-Meier method and Cox regression model.Results: Two-year overall survival rate of the high-dose and standard-dose group was 38.0% and 23.2%, respectively. The 2-year OS rate of stage II, III, and IV was 57.9%, 32.8%, and 20.1%, respectively. Univariate analysis revealed that high dose radiation (≧56 Gy), T classification, M classification, and clinical stage significantly affected overall survival (p= 0.013, 0.016, 0.012, and 0.010, respectively). Multivariate analysis showed that high dose radiation ≧56 Gy (p= 0.030) and clinical stage II-III (p= 0.015) were significant predictors of better OS. In the univariate and multivariate analyses of the patients with M0 disease (n= 49), high dose radiation also has a remarkable impact on LRFS (p= 0.020, 0.003, respectively). Conclusion: Our study showed that higher radiation dose (≧56 Gy) significantly improved OS and LRFS in patients with unresectable ESCC who underwent definitive CCRT using 3DCRT or IMRT techniques. Further randomized clinical studies are required to clarify the benefits and side effects of escalated radiation dose in the setting of modern conformal radiotherapy techniques.

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