食管鳞癌SIB-IMRT疗效及预后因素分析

目的 观察食管鳞癌患者同期推量调强放疗(SIB-IMRT)的疗效并对其相关预后因素进行分析。方法 2009—2015年间101例食管鳞癌患者接受SIB-IMRT,PTV处方剂量5040 cGy分28次(180 cGy/次),PGTV 6020 cGy分28次(215 cGy/次)或6160 cGy分28次(220 cGy/次),1 次/d,5 次/周,全程放疗时间为5.5周。观察其不良反应、治疗失败方式及LC和OS率。结果 1、3、5年样本数分别为101、84、45例。1、3、5年LC率分别为81.6%、70.4%、68.4%,OS率分别为72.3%、49.4%、45.2%,中位生存期36个月。单因素和多因素分析均显示临床分期(Ⅰ/Ⅱ/Ⅲ期)、近期疗效(完全缓解/部分缓解/无缓解)为影响OS的因素(P=0.016、0.000、0.005、0.000)。单次分割215 cGy和220 cGy组LC和OS相近(P=0.283、0.951)。全组1、2、3级急性放射性肺炎发生率分别为10.9%、2.0%、2.0%,1、2、3级急性放射性食管炎发生率分别为63.4%、10.9%、4.0%,无一发生急性食管穿孔和出血。5例患者出现晚期放射性肺炎(2例死亡),1例晚期食管狭窄,2例食管穿孔并出血,2例单纯食管出血。220 cGy组急性放射性肺炎、上消化道反应发生率高于215 cGy组(P=0.062、0.024)。肿瘤局部未控和复发占总治疗失败的62.5%。结论 食管癌SIB-IMRT不良反应可耐受,长期疗效较佳,单次分割220 cGy较215 cGy的LC和OS未提高且增加了不良反应。临床分期、近期疗效为影响生存的预后因素。

Clinical efficacy and prognostic factors of simultaneous integrated boost intensity-modulated radiation therapy for esophageal squamous cell carcinoma

Objective To evaluate the clinical efficacy and analyze relevant prognostic factors of simultaneous integrated boost intensity-modulated radiation therapy (SIB-IMRT) for esophageal squamous cell carcinoma. Methods A total of 101 patients diagnosed with esophageal squamous cell carcinoma received SIB-IMRT from 2009 to 2015. The prescribed dose of PTV was 5040 cGy/28 times (180 cGy/time) and the dose for planning gross tumor volume (PGTV) was 6020 cGy/28 times (215 cGy/time) or 6160 cGy/28 times (220 cGy/time) simultaneously. The total treatment time was 5.5 weeks (once a day,5 times a week).The adverse events, mode of treatment failure,l-,3-and 5-year local control (LC) and overall survival (OS) rates were observed. Results The quantity of patients who completed the 1-,3-and 5-year follow-up was 101, 84 and 45, respectively. The 1-,3-and 5-year LC rates were 81.6%,70.4% and 68.4%, respectively. The 1-,3-and 5-year OS rates were 72.3%,49.4% and 45.2%, respectively. The median survival time was 36 months. Univariate and multivariate analyses showed that clinical staging (stage Ⅰ/Ⅱ/Ⅲ) and tumor response (complete remission/ partial remission/no remission) were the prognostic factors of OS (P=0.016,0.000,0.005,0.000).There were no significant differences in the LC and OS between the two groups of 215 cGy and 220 cGy (P=0.283,0.951).The incidence rates of grade 1,2,3 acute pneumonitis were 10.9%(11/101),2.0%(2/101) and 2.0%(2/101), respectively. The incidence rates of grade 1,2,3 acute esophagitis were 63.4%(64/101),10.9%(11/101) and 4.0%(4/101), respectively. No acute esophageal perforation or hemorrhage occurred. Five patients experienced late pneumonitis (two died). One case developed late lemostenosis, two cases developed esophageal perforation and hemorrhage, and two patients experienced esophageal hemorrhage. The patients treated with a fractionated dose of 220 cGy had a higher incidence rate of acute pneumonitis and upper gastrointestinal adverse reactions than those receiving 215 cGy (P=0.062,0.024).The local failure and recurrence accounted for 62.5% of all treatment-related failures. Conclusions SIB-IMRT yields high long-term clinical efficacy and tolerable adverse events in the treatment of esophageal squamous cell carcinoma. Compared with the dose of 215 cGy, the fractionated dose of 220 cGy fails to improve LC and OS rates, whereas enhances the risk of adverse events. The clinical staging and short-term clinical efficacy are the prognostic factors of survival rate.