食管癌调强放疗同期加量与序贯加量的研究

目的 比较食管癌调强放疗病变局部同期加量与序贯加量的疗效及不良反应。方法回顾分析2006-2015年河北医科大学第四医院收治的行根治性放化疗的330例初治食管癌患者的病历资料。根据治疗方法的不同分为同期加量组(135例)和序贯加量组(195例)。330例患者均接受淋巴引流区预防性照射,经倾向性评分配比(PSM)后,2个组各有105例患者入组。Kaplan-Meier法生存分析,Cox模型多因素预后分析。结果 PSM前同期加量组与序贯加量组1、3、5年局部控制率分别为80.1%、58.3%、46.7%与72.1%、44.9%、40.5%(P=0.050),总生存率分别为81.4%、51.9%、43.5%与80.5%、37.9%、22.3%(P=0.014)。PSM后同期加量组与序贯加量组1、3、5年局部控制率分别为80.2%、54.2%、43.9%与75.5%、47.2%、41.2%(P=0.264),总生存率分别为78.9%、49.0%、40.8%与83.3%、41.7%、24.8%(P=0.265)。多因素分析结果显示同期加量组中TNM分期为独立影响因素,而序贯加量组中TNM分期和化疗为独立影响因素。分层分析结果显示单纯放疗时同期加量组的局部控制率明显高于序贯加量组(P=0.018),总生存率也以同期加量组较高。结论 食管癌根治性放化疗同期加量与序贯加量调强放疗的局部控制率和总生存率基本一致,但单纯放疗时同期加量组的预后生存期明显优于序贯加量组,但仍需大宗病例的多中心研究结果予以佐证。

Comparative study between simultaneous integrated and sequential boost using intensity-modulated radiotherapy for esophageal carcinoma

Objective To compare the clinical efficacy between simultaneous integrated boost (SIB) and sequential boost (SB) using intensity-modulated radiotherapy (IMRT),and investigate the long-term clinical efficacy and adverse events of SIB-IMRT in combination with chemotherapy in the treatment of esophageal cancer. Methods Clinical data of 330 patients diagnosed with esophageal cancer undergoing radical chemoradiotherapy in Fourth Hospital of Hebei University from January 2006 to December 2015 were respectively analyzed. All patients were assigned into the SIB-IMRT (n=135) and SB-IMRT groups (n=195).All patients received definitive radiotherapy with elective nodal irradiation (ENI).After the propensity score matching (PSM),105 patients were enrolled in each group. Kaplan-Meier method was used to survival analysis. Cox model was used to multivariate prognostic analysis. Results Prior to PSM,the 1-,3-and 5-year local control rates were 80.1%,58.3%,46.7% and 72.1%,44.9%,40.5% in the SIB-IMRT and SB-IMRT groups (P=0.050),and the 1-,3-and 5-year OS rates were 81.4%,51.9%,43.5% and 80.5%,37.9%,22.3%(P=0.014),respectively. After the PSM,the 1-,3-and 5-year LC rates were 80.2%,54.2%,43.9% and 75.5%,47.2%,41.2%(P=0.264),and the 1-,3-and 5-year OS rates were 78.9%,49.0%,40.8% and 83.3%,41.7%,24.8%(P=0.265),respectively. Multivariate analysis demonstrated that TNM staging was an independent prognostic factor in the SIB-IMRT group,whereas TNM staging and chemotherapy served as the independent prognostic factors in the SB-IMRT group. Stratified analysis revealed that the LC rate in the SIB-IMRT was significantly higher than that in the SB-IMRT group when radiotherapy alone was performed (P=0.018).The OS rate in the SIB-IMRT group was equally higher compared with that in the SB-IMRT group. Conclusions The LC and OS rates are almost identical after SB-IMRT and SIB-IMRT in the treatment of esophageal cancer,whereas the prognostic survival in the SIB-IMRT group is significantly longer compared with that in the SB-IMRT group during radiotherapy alone. The findings remain to be validated by multi-center investigations with a large sample size.