不能手术食管癌三维放疗与同期放化疗生存比较

目的 不能手术食管癌采用三维放疗技术单纯放疗(RT)与同期放化疗(CCRT)的生存比较。方法 搜集2002—2012年间本院行根治性3DRT和CCRT食管鳞癌480例患者资料,采用倾向配比评分法配对后共296例患者入组,分析比较两组患者生存情况。结果 3DRT和CCRT组3、5年样本数分别为58、48例和58、52例。3DRT和CCRT组3、5年OS分别为32.6%、22.1%和35.1%、26.5%(P=0.463);PFS分别为27.8%、19.8%和30.7%、25.8%(P=0.637)。60~70 Gy亚组3DRT和CCRT的5年OS相近(25.6%和25.3%,P=0.833)、PFS相近(22.7%和25.2%,P=0.999),血道转移率相近(23.4%和24.1%,P=0.899)。50.0~59.9 Gy亚组CCRT 的5年OS和PFS高于3DRT (32.3%∶12.0%,P=0.030和24.1%∶10.6%,P=0.087);3DRT组中60~70 Gy亚组5年OS和PFS明显好于50.0~59.9 Gy亚组(P=0.024和0.041);CCRT组中2个亚组的OS和PFS相近(P=0.791和0.984)。CCRT组不良反应大于3DRT组(主要为食管炎和白细胞下降,P=0.000、0.005),但患者均能耐受。结论 不能手术食管癌患者采用3D放疗技术根治性同期放化疗时建议适当降低放疗剂量, 不能同期放化疗患者给予60~70 Gy放疗也能获得较好生存,但仍需要随机研究的结果证实。

Survival comparison of three-dimensional radiotherapy alone with concurrent chemoradiotherapy for non-surgical esophageal carcinoma

Objective To compare the survival between three-dimensional radiotherapy (3DRT) alone and concurrent chemoradiotherapy (C+3DRT) for non-surgical esophageal carcinoma. Methods Four hundred and eighty patients with esophageal squamous cell carcinoma who were treated with definitive 3DRT or C+3DRT in our institution from 2002 to 2012 were collected and 296 out of them were equally divided into 3DRT group and C+3DRT group. Survival comparison between the two groups was made by propensity score matching method. Patients were mainly given paclitaxel and platinum weekly in C+3DRT. Results The numbers of samples at 3 and 5 years were 58 and 48 in the 3DRT group, and 58 and 52 in the C+3DRT group. The 3-and 5-year overall survival (OS) rates were 32.6% and 22.1% in the 3DRT group, and 35.1% and 26.5% in the C+3DRT group (P=0.463).The 3-and 5-year progression-free survival (PFS) rates were 27.8% and 19.8% in the 3DRT group, and 30.7% and 25.8% in the C+3DRT group (P=0.637). In the 3DRT and C+3DRT groups, patients treated with 60.0－70.0 Gy had similar OS rates (25.6% vs. 25.3%, P=0.833), PFS rates (22.7% vs. 25.2%, P=0.999), and incidence rates of hematogenous metastasis (23.4% vs. 24.1%, P=0.899) at 5 years. Patients treated with 50.0－59.9 Gy had significantly higher 5-year OS and PFS rates in the C+3DRT group than in the 3DRT group (32.3% vs. 12.0%,P=0.030;24.1% vs. 10.6%,P=0.087). In the 3DRT group, patients treated with 60.0－70.0 Gy had significantly higher 5-year OS and PFS rates than those treated with 50.0－59.9 Gy (P=0.024,P=0.041). In the C+3DRT group, patients treated with 60.0－70.0 Gy and 50.0－59.9 Gy had similar 5-year OS and PFS rates (P=0.791,P=0.984). The incidence rates of adverse reactions, such as esophagitis and leukopenia, in the C+3DRT group were significantly higher than those in the 3DRT group (P=0.000,P=0.005). However, those adverse reactions could be tolerated by patients. Conclusions For patients with non-surgical esophageal carcinoma, a low dose in definitive C+3DRT is recommended. 60－70 Gy in 3DRT alone can also achieve a promising survival in patients who cannot receive C+3DRT, which still needs to be confirmed by randomized studies.