Dose escalation in radical radio(chemo)therapy for cervical and upper thoracic esophageal cancer with 3DCRT/IMRT (ChC&UES): a multicenter retrospective study.

IF 3.3 2区医学 Q2 ONCOLOGY

Radiation Oncology Pub Date : 2024-09-27 DOI:10.1186/s13014-024-02521-7

Xiao-Han Zhao, Wen-Cheng Zhang, Xin Wang, Jun-Qiang Chen, Yuan-Ji Xu, Kuai-Le Zhao, Wei Huang, Pu-Dong Qian, Ya-Tian Liu, Xiao-Lin Ge, Xiao-Jie Xia, Chen-Gang Weng, Chun-Yue Gai, He-Song Wang, Hong-Mei Gao, Wen-Bin Shen, Shu-Chai Zhu

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引用次数: 0

Abstract

Background: Cervical and upper thoracic esophageal cancer (ESCA) presents treatment challenges due to limited clinical evidence. This multi-center study (ChC&UES) explores radical radio(chemo)therapy efficacy and safety, especially focusing on radiation dose.

Method: We retrospectively analyzed clinical data from 1,422 cases across 8 medical centers. According to the radiation dose for primary gross tumor, patients were divided into standard dose radiotherapy (SD, 50-55 Gy) or high dose (HD, > 55 Gy) radiotherapy. HD was further subdivided into conventional- high-dose group (HD-conventional, 55-63 Gy) and ultra-high-dose group (HD-ultra, ≥ 63 Gy). Primary outcome was Overall Survival (OS).

Results: The median OS was 33.0 months (95% CI: 29.401-36.521) in the whole cohort. Compared with SD, HD shown significant improved survival in cervical ESCA in Kaplan-Meier (P = 0.029) and cox multivariate regression analysis (P = 0.024) while shown comparable survival in upper thoracic ESCA (P = 0.735). No significant difference existed between HD-conventional and HD-ultra in cervical (P = 0.976) and upper thoracic (P = 0.610) ESCA. Incidences of radiation esophagitis and pneumonia from HD were comparable to SD (P = 0.097, 0.240), while myosuppression risk was higher(P = 0.039). The Bonferroni method revealed that, for both cervical and upper thoracic ESCA, HD-ultra enhance the objective response rate (ORR) compared to SD (P < 0.05).

Conclusion: HD radiotherapy benefits cervical but not upper thoracic ESCA, while increasing bone marrow suppression risk. Further dose escalating (≥ 63 Gy) doesn't improve survival but enhances ORR.

查看原文本刊更多论文

采用3DCRT/IMRT（ChC&UES）对颈部和胸部上段食管癌进行根治性放射（化疗）治疗的剂量升级：一项多中心回顾性研究。

背景：由于临床证据有限，颈部和胸上部食管癌（ESCA）的治疗面临挑战。这项多中心研究（ChC&UES）探讨了根治性放射（化疗）疗法的疗效和安全性，尤其关注放射剂量：我们回顾性分析了 8 个医疗中心 1422 个病例的临床数据。根据原发肿瘤的放射剂量，将患者分为标准剂量放疗（SD，50-55 Gy）和高剂量放疗（HD，> 55 Gy）。高剂量放疗又分为常规-高剂量组（HD-conventional，55-63 Gy）和超高剂量组（HD-ultra，≥ 63 Gy）。主要结果为总生存期（OS）：结果：整个组群的中位生存期为 33.0 个月（95% CI：29.401-36.521）。与标清相比，在 Kaplan-Meier 分析（P = 0.029）和 cox 多变量回归分析（P = 0.024）中，HD 明显提高了颈部 ESCA 的存活率，而在上胸部 ESCA 中，HD 的存活率与标清相当（P = 0.735）。在颈部（P = 0.976）和上胸部（P = 0.610）ESCA 中，HD-常规和 HD-ultra 没有明显差异。HD 与 SD 的放射性食管炎和肺炎发生率相当（P = 0.097，0.240），而肌抑制风险较高（P = 0.039）。Bonferroni法显示，对于颈椎和上胸椎ESCA，HD-ultra比SD提高了客观反应率（ORR）（P 结论：HD-ultra可提高颈椎和上胸椎ESCA的客观反应率：高清放疗对颈椎ESCA有益，但对上胸椎ESCA无益，同时会增加骨髓抑制风险。进一步加大剂量（≥ 63 Gy）不会提高生存率，但会提高 ORR。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Radiation Oncology ONCOLOGY-RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

CiteScore

6.50

自引率

2.80%

发文量

181

审稿时长

3-6 weeks

期刊介绍： Radiation Oncology encompasses all aspects of research that impacts on the treatment of cancer using radiation. It publishes findings in molecular and cellular radiation biology, radiation physics, radiation technology, and clinical oncology.