食管鳞癌术后纵隔淋巴结复发患者SIB-IMRT的疗效和安全性研究  

Long-term outcomes of SIB intensity-modulated radiation therapy for patients with recurrent mediastinal lymph nodes after radical resection of esophageal squamous cell carcinoma:a phaseⅠ/Ⅱ prospective single-arm clinical study

作　　者：杜尕金措 李淑艳 李欢 郑思悦 易培强 祁伟祥 赵胜光[2] Du Gajincuo;Li Shuyan;Li Huan;Zheng Siyue;Yi Peiqiang;Qi Weixiang;Zhao Shengguang(Department of Oncology,QingHai Provincial People's Hospital,Xining 810000,China;Department of Radiation Oncology,Ruijin Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200025,China;ShangHai Ruijin Hospital)

机构地区：[1]青海省人民医院肿瘤内科,西宁810000 [2]上海交通大学医学院附属瑞金医院放疗科,上海200025 [3]上海瑞金医院

出　　处：《中华放射肿瘤学杂志》2023年第12期1051-1056,共6页Chinese Journal of Radiation Oncology

基　　金：国家自然科学基金青年项目(82102819);上海市杨帆计划(21YF1427700)。

摘　　要：目的观察食管鳞癌根治术后纵隔淋巴结复发患者采用同步加量调强放疗(SIB-IMRT)的长期疗效和晚期不良反应。方法前瞻性研究2019年6月至2021年12月期间就诊于上海瑞金医院放疗科的食管鳞癌术后纵隔淋巴结复发(≤5枚)的患者共20例, 其中Ⅰ、Ⅱ期研究各纳入10例患者, 4、3、13例患者分别接受58.8 Gy分28次、64.4 Gy分28次、70 Gy分28次3个剂量等级的SIB-IMRT。使用Kaplan-Meier法计算入组患者的总生存(OS)率、局部控制率(LCR)及无进展生存(PFS)率, 并对不良反应进行分析。结果纵隔淋巴结最常见的复发部位为2R和4L, 分别占35%和25%。中位随访32个月, 复发后接受挽救性SIB-IMRT者的1、2、3年OS率分别为100%、88%、78%, 1、2、3年PFS率分别为85%、78%、78%。最常见的血液学不良反应是白细胞减少和贫血。最常见的非血液学不良反应是食管炎, 但未发现3级及以上食管炎、肺炎和心脏不良反应。随访中3例接受58.8 Gy分28次剂量的患者在治疗后2年出现肿瘤远处转移死亡, 另外1例接受70 Gy分28次剂量的患者在治疗后16个月出现肿瘤远处转移死亡。结论对于食管鳞癌根治术后纵隔淋巴结复发患者, 采用SIB-IMRT挽救性同步放化疗方案具有较高的有效性和安全性。Objective To observe the long-term efficacy and late adverse reactions of simultaneous integrated boost intensity-modulated radiotherapy(SIB-IMRT)for mediastinal lymph node recurrence after radical surgery for esophageal squamous cell carcinoma(ESCC).Methods A total of 20 EscC patients with mediastinal lymph node recurrence(<5)after radical surgery admitted to Department of Radiotherapy,Shanghai Ruijin Hospital between June 2019 and December 2021 were enrolled in this prospective study.Among them,10 patients were enrolled in phase I study and 10 patients in phase II study.Four,3 and 13 patients received three different doses of SIB-IMRT at 58.8 Gy/28 fractions,64.4 Gy/28 fractions and 70.0 Gy/28 fractions for recurrent lesions,respectively.The overall survival(OS)rate,local control rate(LCR)and progression-free survival(PFS)were calculated by Kaplan-Meier analysis.Adverse reactions were also analyzed.Results The most common sites of recurrence were 2R and 4 L,accounting for 35%and 25%,respectively.The median follow-up time was 32 months.For patients who received salvage chemoradiation after relapse,the 1-,2-and 3-year 0S rates were 100%,88%and 78%,the 1-,2-and 3-year PFS rates were 85%,78%and 78%,respectively.The most common hematological toxicities were leukocytopenia and anemia.The most common nonhematological toxicity was esophagitis.However,no grade 3 or above esophagitis,pneumonia and cardiotoxicity were found.Three patients who received SIB-IMRT at 58.8 Gy/28 fractions died of distant metastases at 2 years after treatment,and 1 patient who received SIB-IMRT at 70.0 Gy/28 fractions died of distant metastases at 16 months after treatment.Conclusion Salvage chemoradiotherapy using SIB-IMRT is efficacious and safe for mediastinal lymph node recurrence in EscC patients after radical resection.

关 键 词：食管肿瘤 纵隔淋巴结复发 挽救性放化疗法 放射疗法 同步加量 临床试验 

分 类 号：R735.1[医药卫生—肿瘤]