| 郭宁,王巍伟,王勇,等.同步加量调强放疗对颈胸上段食管癌患者长期预后的影响[J].中华放射医学与防护杂志,2022,42(1):32-39.Guo Ning,Wang Weiwei,Wang Yong,et al.Analysis of the long-term prognosis of patients with cervical and upper thoracic esophageal cancer treated with simultaneous integrated boost intensity-modulated radical radiotherapy[J].Chin J Radiol Med Prot,2022,42(1):32-39 |
| 同步加量调强放疗对颈胸上段食管癌患者长期预后的影响 |
| Analysis of the long-term prognosis of patients with cervical and upper thoracic esophageal cancer treated with simultaneous integrated boost intensity-modulated radical radiotherapy |
| 投稿时间：2021-09-17 |
| DOI：10.3760/cma.j.cn112271-20210917-00382 |
| 中文关键词: 颈段食管癌 胸上段食管癌 同步整合加量调强放疗 预后 倾向性评分匹配分析 |
| 英文关键词:Cervical esophageal cancer Upper thoracic esophageal cancer Simultaneous integrated booted intensity-modulated radiotherapy Prognosis Propensity score matching analysis |
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| 中文摘要: |
| 目的 评估同步加量调强放疗（SIB-IMRT）对颈、胸上段食管癌患者长期预后的影响。方法 对2011年1月至2014年12月，接受IMRT的颈、胸上段食管癌的172例患者进行了回顾性分析。首先对全组患者的预后进行了单因素和多因素分析，依据患者照射方式，将全组患者分为常规IMRT （C-IMRT）和SIB-IMRT两组，应用倾向性评分匹配（PSM）分析对接受C-IMRT和SIB-IMRT的两组患者进行配比，并分析PSM后患者的疗效、预后影响因素、治疗失败模式和不良反应等。结果 全组患者中位总生存（OS）和无进展生存（PFS）时间分别为30和20个月。食管病变周边组织器官是否受侵、cN分期、化疗和GTV-最大横径为影响全组患者OS和PFS的独立性影响因素（P < 0.001、P=0.013、0.005、0.002；P < 0.001、P=0.017、0.034、0.002），影响PFS的独立性因素还有近期疗效（P=0.036）。PSM后C-IMRT和SIB-IMRT两组患者各有54例，多因素分析结果显示，食管病变周边组织器官是否受侵、cN分期、cTNM分期、处方剂量、GTV-最大横径和照射方式为影响患者OS的独立性因素（P < 0.001、P=0.008、0.014、0.021、0.010、0.008），食管病变周边组织器官是否受侵、cN分期和大体肿瘤靶区GTV-最大横径是影响患者PFS的独立性因素（P < 0.001、P=0.044、0.013）。C-IMRT和SIB-IMRT两组患者治疗后总失败率（70.4%vs. 50.0%）和局部区域复发率（61.1%vs. 31.5%）的差异有统计学意义（χ2=4.68、9.53，P=0.031、0.002）。C-IMRT组的≥1级的放射性肺炎发生率显著高于SIB-IMRT组（χ2=6.16，P=0.046）；而≥2级白细胞抑制低于后者（χ2=12.77，P=0.005）。结论 与C-IMRT相比，SIB-IMRT在一定程度上提高和改善了颈、胸上段食管癌患者的OS，能否改善患者的PFS需要进一步的研究。 |
| 英文摘要: |
| Objective To evaluate the effects of simultaneous integrated boost intensity-modulated radical radiotherapy (SIB-IMRT) on the long-term prognosis of patients with cervical and upper thoracic esophageal cancer.Methods From January 2011 to December 2014, a retrospective analysis was performed in 172 patients with cervical and upper thoracic esophageal cancer who were eligible for IMRT. First, the prognosis of all the patients was evaluated using single factor and multivariate analyses. According to the different irradiation method of the patients, the patients were divided into two groups, one of which received conventional IMRT (C-IMRT) and the other of which received SIB-IMRT. Propensity score matching (PSM) analysis was applied to match the two groups of patients and to determine the treatment efficacy of patients after PSM, prognostic factors, failure modes, and side effects. SPSS19.0 statistical software was used to conduct statistical analysis.Results The median overall survival (OS) and progression-free survival (PFS) times of all the patients were 30 months and 20 months, respectively. The fact whether the surrounding tissues and organs of esophageal lesions were invaded, clinical node staging (cN staging), chemotherapy, and GTV-maximum transverse diameter were observed to be independent influencing factors of OS and PFS in all the patients (P < 0.001, P=0.013, 0.005, 0.002; P < 0.001, P=0.017, 0.034, 0.002). In addition, the independent influencing factors of PFS showed short-term efficacy (P=0.036). After PSM, there were 54 patients in each of the two groups. The result of multivariate analysis showed that the fact whether the surrounding tissues and organs of esophageal lesions were invaded, cN staging, cTNM staging, prescribed dose, GTV-maximum transverse diameter, and irradiation method were independent factors affecting the OS (P < 0.001, P=0.008, 0.014, 0.021, 0.010, 0.008). Similarly, the fact whether the surrounding tissues and organs of esophageal lesions were invaded, cN staging, and GTV-maximum transverse diameter were observed to be independent factors that affect the PFS of patients (P < 0.001, P=0.044, 0.013). The difference in the total failure rate (70.4% vs. 50.0%) and the local regional recurrence rate (61.1% vs. 31.5%) between the C-IMRT and SIB-IMRT groups after treatment was significant (χ2=4.68, 9.53, P=0.031, 0.002). The incidence of radiation pneumonitis of grade ≥ 1 in the C-IMRT group was significantly higher than that of the SIB-IMRT group (χ2=6.16, P=0.046), whereas the leukocyte suppression of grade ≥ 2 in the C-IMRT group was significantly lower than that in the SIB-IMRT group (χ2=12.77, P=0.005).Conclusions As shown by the result of this study, compared with C-IMRT, SIB-IMRT can improve the OS of patients with cervical and upper thoracic esophageal cancer to a certain extent. Whether SIB-IMRT can improve the PFS of patients requires further research. |
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