- 作者：Steven H. Lin ; M.D. ; Ph.D.&lowast ; ; shlin@mdanderson.org ; Ritsuko Komaki ; M.D.&lowast ; ; Zhongxing Liao ; M.D.&lowast ; ; Caimiao Wei ; Ph.D.&Dagger ; ; Bevan Myles ; M.D.&lowast ; ; Xiaomao Guo ; M.D.鈥?/sup> ; Matthew Palmer ; M.B.A. ; C.M.D.&lowast ; ; Radhe Mohan ; Ph.D.&dagger ; ; Stephen G. Swisher ; M.D.§ ; ; Wayne L. Hofstetter ; M.D.§ ; ; Jaffer A. Ajani ; M.D.¶ ; ; James D. Cox ; M.D.&lowast ;
- 关键词：Chemoradiation ; Chemotherapy ; Esophageal cancer ; Protons
- 刊名：International Journal of Radiation Oncology*Biology*Physics
- 出版年：2012
- 期刊代码：136_03603016
- 类别：med
- 出版时间：1 July, 2012
- 卷：83
- 期：3
- 页码：e345-e351
- 文件大小：707 K
Purpose
Proton beam therapy (PBT) is a promising modality for the management of thoracic malignancies. We report our preliminary experience of treating esophageal cancer patients with concurrent chemotherapy (CChT) and PBT (CChT/PBT) at MD Anderson Cancer Center.Methods and Materials
This is an analysis of 62 esophageal cancer patients enrolled on a prospective study evaluating normal tissue toxicity from CChT/PBT from 2006 to 2010. Patients were treated with passive scattering PBT with two- or three-field beam arrangement using 180 to 250 MV protons. We used the Kaplan-Meier method to assess time-to-event outcomes and compared the distributions between groups using the log-rank test.
Results
The median follow-up time was 20.1 months for survivors. The median age was 68 years (range, 38-86). Most patients were males (82%) who had adenocarcinomas (76%) and Stage II-III disease (84%). The median radiation dose was 50.4 Gy (RBE [relative biologic equivalence]) (range, 36-57.6). The most common grade 2 to 3 acute toxicities from CChT/PBT were esophagitis (46.8%), fatigue (43.6%), nausea (33.9%), anorexia (30.1%), and radiation dermatitis (16.1%). There were two cases of grade 2 and 3 radiation pneumonitis and two cases of grade 5 toxicities. A total of 29 patients (46.8%) received preoperative CChT/PBT, with one postoperative death. The pathologic complete response (pCR) rate for the surgical cohort was 28%, and the pCR and near CR rates (0%-1%residual cells) were 50%. While there were significantly fewer local-regional recurrences in the preoperative group (3/29) than in the definitive CChT/PBT group (16/33) (log-rank test, p = 0.005), there were no differences in distant metastatic (DM)-free interval or overall survival (OS) between the two groups.
Conclusions
This is the first report of patients treated with PBT/CChT for esophageal cancer. Our data suggest that this modality is associated with a few severe toxicities, but the pathologic response and clinical outcomes are encouraging. Prospective comparison with more traditional approach is warranted.