局部晚期胸段食管鳞癌同步加量调强放疗联合化疗的疗效及不良反应分析  

Efficacy and toxicity of simultaneous integrated boost intensity modulated radiation therapy combined with concurrent chemotherapy in patients with locally advanced thoracic esophageal squamous cell carcinoma

作　　者：陈虹悯 刘佳[2] 邓中华 赖佳路 李安[3] 张英杰[3] 桑旦旺姆 宫友陵[1] 周麟[1] Chen Hongmin;Liu Jia;Deng Zhonghua;Lai Jialu;Li An;Zhang Yingjie;Sang Danwangmu;Gong Youling;Zhou Lin(Department of Thoracic Oncology,Cancer Center and State Key Laboratory of Biotherapy,West China Hospital,Sichuan University,Chengdu 610041,China;Department of Oncology,Chengdu First People's Hospital,Chengdu 610041,China;Department of Radiotherapy,Cancer Center,West China Hospital,Sichuan University,Chengdu 610041,China;Department of Oncology,People's Hospital of Tibet Autonomous Region,Lhasa 850000,China)

机构地区：[1]四川大学华西医院肿瘤中心,生物治疗国家重点实验室,胸部肿瘤科,四川成都610041 [2]成都市第一人民医院肿瘤科,四川成都610041 [3]四川大学华西医院肿瘤中心放疗科,四川成都610041 [4]西藏自治区人民医院肿瘤科,西藏自治区拉萨850000

出　　处：《实用肿瘤杂志》2023年第1期46-53,共8页Journal of Practical Oncology

摘　　要：目的分析同步加量调强放疗(simultaneous integrated boost intensity modulated radiation therapy,SIB-IMRT)联合化疗治疗局部晚期胸段食管鳞癌的疗效及不良反应。方法回顾性纳入2017年2月至2018年7月于四川大学华西医院收治的43例接受SIB-IMRT联合化疗的局部晚期胸段食管鳞癌患者。放疗剂量为预防区域50.4 Gy/28 f,1.8 Gy/f,5 f/周,同步肿瘤区域推量至60~66 Gy/28 f,2.14~2.35 Gy/f,5 f/周,化疗方案为紫杉醇/多西他赛+顺铂,化疗2~4个周期。分析患者的复发模式、生存状况及不良反应情况。结果全组患者中位随访时间为30个月,治疗后客观缓解率为81.4%(35/43),疾病控制率为100%(43/43)。1年和3年局部无进展生存率、无进展生存率、无远处转移生存率及总生存率分别为74.3%和35.4%、59.9%和30.4%、64.7%和29.4%及83.5%和35.5%。治疗后3~4级不良反应主要为白细胞减少(23.2%)及放射性食管炎(14.0%),其中2例出现食管气管瘘,1例出现食管纵隔瘘。T分期和临床分期为影响总生存的独立预后因素,T分期为影响无进展生存的独立预后因素,肿瘤靶区体积(gross target volume,GTV)为影响局部无进展生存的独立预后因素,而年龄、T分期、N分期、临床分期及肿瘤长度为影响无远处转移生存的独立预后因素(均P<0.05)。结论SIB-IMRT对局部晚期食管鳞癌患者整体来看安全有效,但需警惕治疗前气管受侵或深溃疡患者有穿孔风险。Objective To analyze the efficacy and toxicity of simultaneous integrated boost intensity modulated radiation therapy(SIB-IMRT)combined with concurrent chemotherapy in the treatment of locally advanced thoracic esophageal squamous cell carcinoma.Methods A total of 43 patients with locally advanced thoracic esophageal squamous cell carcinoma who received SIB-IMRT combined with concurrent chemotherapy from February 2017 to July 2018 in West China Hospital,Sichuan University,were retrospectively recruited.The radiotherapy doses of 50.4 Gy/28 f,1.8 Gy/f,5 f/week and 60-66 Gy/28 f,2.14-2.35 Gy/f,5 f/week were prescribed for the planning target volume and planning gross tumor volume.Concurrent chemotherapy of paclitaxel or docetaxel plus cisplatin was prescribed for all patients for 2-4 cycles.The recurrence pattern,survival status and adverse reactions of patients were analyzed.Results The median follow-up time of all patients was 30 months.The objective response rate was 81.4%(35/43)and the disease control rate was 100%(43/43).The 1-year and 3-year local regional recurrence-free survival(LRFS),overall survival(OS),distant metastasis-free survival(DMFS),and progression-free survival(PFS)rates were 74.3%and 35.4%,83.5%and 35.5%,64.7%and 29.4%,and 59.9%and 30.4%,respectively.The main grade 3-4 treatment related adverse events were leukopenia(23.2%)and radiation esophagitis(14.0%).Two patients developed tracheoesophageal fistula,and one patient developed esophagomediastinal fistula after this treatment.Multivariate analysis demonstrated that T stage and clinical stage were independent prognostic factors for OS,while T stage was an independent prognostic factor for PFS,gross target volume was an independent prognostic factor for LRFS,and age,T stage,N stage,clinical stage and the length of primary tumor were independent prognostic factors for DMFS(all P<0.05).Conclusions SIB-IMRT concurrent with chemotherapy is effective and tolerable for patients with locally advanced thoracic esophageal squamous cell carcinoma.However,t

关 键 词：食管鳞癌 同步加量调强放疗 疗效 不良反应 

分 类 号：R735.1[医药卫生—肿瘤]