食管癌根治性放化疗后局部复发挽救性放疗长期疗效分析  

Long-term efficacy analysis of salvage re-irradiation therapy for patients with locally recurrent esophageal cancer after definitive chemoradiotherapy

作　　者：高光斌 郑晨 李启慧 刘青[1] 焦文鹏 武亚晶 程云杰[1] 翟畅 刘月平[1] 王军[1] Gao Guangbin;Zheng Chen;Li Qihui;Liu Qing;Jiao Wenpeng;Wu Yajing;Cheng Yunjie;Zhai Chang;Liu Yueping;Wang Jun(Department of Radiation Oncology,Fourth Hospital of Hebei Medical University,Shijiazhuang 050011,China)

机构地区：[1]河北医科大学第四医院放疗科,石家庄050011

出　　处：《中华放射肿瘤学杂志》2024年第8期711-718,共8页Chinese Journal of Radiation Oncology

基　　金：河北省肿瘤放射与治疗临床医学研究中心创新能力提升(20577702D)。

摘　　要：目的分析食管鳞癌根治性放化疗后食管局部复发挽救性放疗患者的临床特征、近期疗效和不良反应,探讨在精准照射技术条件下再程放疗的预后相关因素。方法回顾性分析河北医科大学第四医院2008年1月至2016年12月期间收治的局晚期食管鳞癌根治性放化疗后局部复发患者资料。患者行再程放疗或同步放化疗,主要观察指标为复发后生存时间,采用Kaplan-Meier法生存分析计算复发后生存时间,log-rank检验进行单因素分析,Cox回归模型进行多因素分析。结果纳入患者109例,中位年龄66岁(43~89岁),中位随访时间120.8个月(79.0~176.5个月),全组患者客观缓解率和吞咽困难改善率分别为64.2%和63.0%。全组患者中位复发后生存时间为7.8个月,1、3、5、8年的生存率分别为32.1%、9.2%、7.3%、2.3%。复发间隔时间≥24个月组中位复发后生存期和1、3、5年生存率分别为10.8个月和45.9%、13.5%、10.8%,显著优于<24个月组的5.7个月和25.0%、6.9%、5.6%(χ2=7.99,P=0.005)。再程放疗剂量≤50 Gy组、>50~54 Gy组、>54 Gy组中位复发后生存期分别为5.7、10.0、8.1个月(χ2=6.94,P=0.031)。再程放疗组和同步放化疗组1、3、5年生存率分别为30.4%、5.1%、3.8%和36.7%、20.0%、16.7%(χ2=2.12,P=0.145)。多因素分析显示复发间隔时间(HR=0.607,95%CI为0.372~0.991,P=0.046)和病变长度(HR=0.603,95%CI为0.371~0.982,P=0.042)是复发后生存时间的独立影响因素。再程放疗组与同步放化疗组≥2级放射性肺炎、2-3级放射性食管炎的发生率差异均无统计学意义(χ2=0.25,P=0.619;χ2=0.51,P=0.808)。再程放疗组≥2级骨髓抑制发生率显著低于同步放化疗组(3.7%∶36.7%,χ2=18.15,P<0.001)。结论食管鳞癌根治性放化疗后食管局部复发再程精准放疗可以改善吞咽困难,但复发后长期生存仍然较差。再程放疗剂量范围在>50~54 Gy可能是较好的治疗选择。复发间隔时间≥24个月、病变长度≤5 cObjectiveTo analyze clinical features,short-term efficacy and side effects of salvage re-irradiation therapy for patients with locally recurrent esophageal cancer after definitive chemoradiotherapy,to investigate the prognostic factors of re-irradiation with precise radiotherapy techniques.MethodsA retrospective analysis was performed on patients with locally recurrent esophageal squamous cell carcinoma after definitive chemoradiotherapy treated in the Fourth Hospital of Hebei Medical University from January 2008 to December 2016.The patients underwent re-irradiation therapy(re-RT)or re-irradiation therapy concurrent chemotherapy(re-CCRT).The main observation index was after-recurrence survival(ARS),which was calculated by Kaplan-Meier method for survival analysis.Univariate analysis was conducted by log-rank test,and multivariate analysis was performed by Cox regression model.ResultsA total of 109 patients were included,with a median age of 66 years(43-89 years),and a median follow-up time of 120.8 months(79.0-176.5 months).The objective response rates(ORR)and dysphagia improvement rates(DIR)in all patients were 64.2%and 63.0%,respectively.The median ARS and 1-,3-,5-,8-year survival rates in all patients were 7.8 months and 32.1%,9.2%,7.3%and 2.3%,respectively.The median ARS and 1-,3-,5-years survival rates were 10.8 months and 45.9%,13.5%,10.8%for patients with time to recurrence(TTR)≥24 months,significantly longer than those of 5.7 months and 25.0%,6.9%,5.6%for patients with TTR<24 months(χ2=7.99,P=0.005).The median ARS in groups with re-irradiation dose of≤50 Gy,>50-54 Gy,and>54 Gy groups were 5.7,10.0 and 8.1 months,respectively(χ2=6.94,P=0.031).The 1-,3-and 5-year survival rates were 30.4%,5.1%,and 3.8%for re-RT versus 36.7%,20.0%,and 16.7%for re-CCRT(χ2=2.12,P=0.145).Multivariate analysis showed that TTR(HR=0.607,95%CI=0.372-0.991,P=0.046)and lesion length(HR=0.603,95%CI=0.371-0.982,P=0.042)were the independent factors for ARS.There was no significant difference in≥2 grade pneumonitis and 2-3 grad

关 键 词：食管肿瘤 根治性放化疗法 复发 再程放疗 预后 

分 类 号：R735.1[医药卫生—肿瘤]