选择性增加PTV单次剂量对食管癌患者预后的影响
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摘要
目的探讨选择性增加PTV单次剂量对食管癌患者预后的影响。方法收集接受治疗的食管癌患者302例,进行预后影响因素分析,并比较不同PTV单次剂量的两组患者的构成比,依据Cox多因素分析结果,应用PSM法进行1:1匹配,分析匹配后两组患者的预后影响因素。结果全组患者中位OS为30.0月(HR:3.319, 95%CI:23.495～36.505),中位DFS为21.3月(HR:1.838, 95%CI:7.698～24.902)。多因素分析结果显示,化疗、cTNM分期和PTV单次剂量为OS(均P<0.05)和DFS(均P<0.05)的独立预后影响因素。依据多因素分析结果进行PSM分析,经1:1配比后每组患者90例。PSM后多因素分析结果显示,cTNM分期和PTV单次剂量为患者OS独立预后影响因素;化疗、cTNM分期和PTV单次剂量为患者DFS独立预后影响因素;两组患者≥2级急性不良反应发生率差异无统计学意义(均P>0.05)。SIB-IMRT组中PTV单次剂量为2 Gy和>2 Gy的患者亚组分析结果显示,后者的OS和DFS均显著性优于前者(均P<0.05)。结论选择性增加PTV单次剂量可改善接受根治性放(化)疗食管癌患者的生存情况,而不增加其不良反应。
Objective To investigate the effect of selective increase of the single dose of PTV on the prognosis of patients with esophageal cancer. Methods A total of 302 patients with esophageal cancer who were treated in the Fourth Hospital of Hebei Medical University. The prognostic factors of the whole group were analyzed, and the composition ratios of the two groups with different single doses of PTV were compared. According to the Cox multi-factor analysis results, the PSM method was used for 1:1 matching,and the prognostic factors of the matched two groups were analyzed. Results The median OS of the whole group was 30.0 months(HR: 3.319, 95%CI: 23.495-36.505), and the median DFS was 21.3 months(HR:1.838, 95%CI: 7.698-24.902). Multivariate analysis showed that chemotherapy, cTNM staging, and the single dose of PTV were independent prognostic factors for OS(all P<0.05) and DFS(all P<0.05). According to the multivariate analysis results, 90 patients in each group were compared with 1:1 after PSM. After PSM,multivariate analysis results showed that cTNM staging and the single dose of PTV were the independent prognosis influencing factors of OS; chemotherapy, cTNM staging and the single dose of PTV were the independent prognostic factors of DFS; there was no significant difference in ≥2 grade acute side effects between the two groups(all P>0.05). Subgroup analysis of patients with a single dose of 2 Gy and >2 Gy in the SIB-IMRT group showed that the OS and DFS of the latter were significantly better than the former(all P<0.05). Conclusion The selective increase of the single dose of PTV could improve the survival of patients undergoing radicalized esophageal cancer without increasing the side effects.
Objective To investigate the effect of selective increase of the single dose of PTV on the prognosis of patients with esophageal cancer. Methods A total of 302 patients with esophageal cancer who were treated in the Fourth Hospital of Hebei Medical University. The prognostic factors of the whole group were analyzed, and the composition ratios of the two groups with different single doses of PTV were compared. According to the Cox multi-factor analysis results, the PSM method was used for 1:1 matching,and the prognostic factors of the matched two groups were analyzed. Results The median OS of the whole group was 30.0 months(HR: 3.319, 95%CI: 23.495-36.505), and the median DFS was 21.3 months(HR:1.838, 95%CI: 7.698-24.902). Multivariate analysis showed that chemotherapy, cTNM staging, and the single dose of PTV were independent prognostic factors for OS(all P<0.05) and DFS(all P<0.05). According to the multivariate analysis results, 90 patients in each group were compared with 1:1 after PSM. After PSM,multivariate analysis results showed that cTNM staging and the single dose of PTV were the independent prognosis influencing factors of OS; chemotherapy, cTNM staging and the single dose of PTV were the independent prognostic factors of DFS; there was no significant difference in ≥2 grade acute side effects between the two groups(all P>0.05). Subgroup analysis of patients with a single dose of 2 Gy and >2 Gy in the SIB-IMRT group showed that the OS and DFS of the latter were significantly better than the former(all P<0.05). Conclusion The selective increase of the single dose of PTV could improve the survival of patients undergoing radicalized esophageal cancer without increasing the side effects.
引文
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[14]白文文,付丽媛,李静,等.食管癌同期推量调强放疗和后程缩野加量调强放疗的临床对比研究[J].中华放射医学与防护杂志,2018,38(4):258-64.[Bai WW,Fu LY,Li J,et al.Comparison of simultaneous integrated boost and late course boost intensitymodulated radiation therapy in the treatment of esophageal carcinoma[J].Zhonghua Fang She Yi Xue Yu Fang Hu Za Zhi,2018,38(4):258-64.]
[15]Fowler JF.Rapid repopulation in radiotherapy:a debate on mechanism.The phantom of tumortreatment-continually rapid proliferation unmasked[J].Radiother Oncol,1991,22(3):156-8.
[16]朱健,岳晨曦,尹勇,等.针对单次大剂量放疗的LQ及BED模型研究进展[J].中华放射肿瘤学杂志,2018,27(9):859-63.[Zhu J,Yue CX,Yin Y,et al.Research progress on linear quardratic and biological equivalent dose models for hig-dose-perfractionradiotherapy[J].Zhonghua Fang She Zhong Liu Xue Za Zhi,2018,27(9):859-63.]
[17]Yu W,Cai XW,Liu Q,et al.Safety of dose escalation by simultaneous integrated boosting radiation dose within the primary tumor guided by(18)FDG-PET/CT for esophageal cancer[J].Radiother Oncol,2015,114(2):195-200.
[18]Zhang WZ,Chen JZ,Li DR,et al.Simultaneous modulated accelerated radiation therapy for esophageal cancer:a feasibility study[J].World J Gastroenterol,2014,20(38):13973-80.
[19]任雪姣,刘丽虹,王澜,等.548例食管癌3DRT的GTV受量分析与预后[J].中华放射肿瘤学杂志,2016,25(11):1172-6.[Ren XJ,Liu LH,Wang L,et al.Gross tumor volume dosimetry and prognosis of esophageal carcinoma treatwith three-dimensional radiotherapy:a study of 548 patients[J].Zhonghua Fang She Zhong Liu Xue Za Zhi,2016,25(11):1172-6.]
[20]白文文,宋玉芝,乔永志,等.食管鳞癌SIB-IMRT疗效及预后因素分析[J].中华放射肿瘤学杂志,2018,27(6):570-5.[Bai WW,Song YZ,Qiao YZ,et al.Clinical efficacy and probnosis factors of simultaneous integrated boost intensity-modulated radiation therapr for esophageal sequamous cell carcinoma[J].Zhonghua Fang She Zhong Liu Xue Za Zhi,2018,27(6):570-5.]
[2]Minsky BD,Pajak TF,Ginsberg RJ,et al.INT 0123(Radiation Therapy Oncology Group 94-05)phaseⅢtrial of combinedmodality therapy for esophageal cancer:high-dose versus standard-dose radiation therapy[J].J Clin Oncol,2002,20(5):1167-74.
[3]沈文斌,祝淑钗.食管癌术后患者放化疗临床应用研究进展[J].肿瘤防治研究,2015,42(6):535-40.[Shen WB,Zhu SC.Progress of clinical application of radiochemotherapy after esophagectomy[J].Zhong Liu Fang Zhi Yan Jiu,2015,42(6):535-40.]
[4]Shukovsky LJ,Fletcher GH.Time-dose and tumor volume relationships in the irradiation of squamous cell carcinoma of the tonsillar fossa[J].Radiology,1973,107(3):621-6.
[5]Lin SH,Wang L,Myles B,et al.Propensity score-based comparison of long-term outcomes with 3-dimensional conformal radiotherapy vs.intensity-modulated radiotherapy for esophageal cancer[J].Int J Radiat Oncol Biol Phys,2012,84(5):1078-85.
[6]Zhang Z,Liao Z,Jin J,et al.Dose-response relationship in locoregional control for patients with stageⅡ-Ⅲesophageal cancer treated with concurrent chemotherapy and radiotherapy[J].Int J Radiat Oncol Biol Phys,2005,61(3):656-64.
[7]Welsh J,Palmer MB,Ajani JA,et al.Esophageal cancer dose escalation using a simultaneous integrated boost technique[J].Int J Radiat Oncol Biol Phys,2012,82(1):468-74.
[8]Yu WW,Zhu ZF,Fu XL,et al.Simultaneous integrated boost intensity-modulated radiotherapy in esophageal carcinoma Early results of a phaseⅡstudy[J].Strahlenther Onkol,2014,190(11):979-86.
[9]Fu WH,Wang LH,Zhou ZM,et al.Comparison of conformal and intensity-modulated techniques for simultaneous integrated boost radiotherapy of upper esophageal carcinoma[J].World JGastroenterol,2004,10(8):1098-102.
[10]Geh JI,Bond SJ,Bentzen SM,et al.Systematic overview of preoperative(neoadjuvant)chemoradiotherapy trials in oesophageal cancer:evidence of a radiation and chemotherapy dose response[J].Radiother Oncol,2006,78(3):236-44.
[11]Bednarek C,Crehange G,Quivrin M,et al.Mapping of failures after radiochemotherapy in patients with non-metastatic esophageal cancer;a posteriori analysis of the dose distribution in the sites of loco-regional relapse[J].Radiother Oncol,2015,116(2):252-6.
[12]Chen JZ,Guo H,Zhai T,et al.Radiation dose escalation by simultaneous modulated accelerated radiotherapy combined with chemotherapy for esophageal cancer:a phaseⅡstudy[J].Oncotarget,2016,7(16):22711-9.
[13]Zeng M,Aguila FN,Patel T,et al.Intensity modulated radiation therapy with simultaneous integrated boost based dose escalation on neoadjuvant chemoradiation therapy for locally advanced distal esophageal adenocarcinoma[J].World J Gastrointest Oncol,2016,8(5):474-80.
[14]白文文,付丽媛,李静,等.食管癌同期推量调强放疗和后程缩野加量调强放疗的临床对比研究[J].中华放射医学与防护杂志,2018,38(4):258-64.[Bai WW,Fu LY,Li J,et al.Comparison of simultaneous integrated boost and late course boost intensitymodulated radiation therapy in the treatment of esophageal carcinoma[J].Zhonghua Fang She Yi Xue Yu Fang Hu Za Zhi,2018,38(4):258-64.]
[15]Fowler JF.Rapid repopulation in radiotherapy:a debate on mechanism.The phantom of tumortreatment-continually rapid proliferation unmasked[J].Radiother Oncol,1991,22(3):156-8.
[16]朱健,岳晨曦,尹勇,等.针对单次大剂量放疗的LQ及BED模型研究进展[J].中华放射肿瘤学杂志,2018,27(9):859-63.[Zhu J,Yue CX,Yin Y,et al.Research progress on linear quardratic and biological equivalent dose models for hig-dose-perfractionradiotherapy[J].Zhonghua Fang She Zhong Liu Xue Za Zhi,2018,27(9):859-63.]
[17]Yu W,Cai XW,Liu Q,et al.Safety of dose escalation by simultaneous integrated boosting radiation dose within the primary tumor guided by(18)FDG-PET/CT for esophageal cancer[J].Radiother Oncol,2015,114(2):195-200.
[18]Zhang WZ,Chen JZ,Li DR,et al.Simultaneous modulated accelerated radiation therapy for esophageal cancer:a feasibility study[J].World J Gastroenterol,2014,20(38):13973-80.
[19]任雪姣,刘丽虹,王澜,等.548例食管癌3DRT的GTV受量分析与预后[J].中华放射肿瘤学杂志,2016,25(11):1172-6.[Ren XJ,Liu LH,Wang L,et al.Gross tumor volume dosimetry and prognosis of esophageal carcinoma treatwith three-dimensional radiotherapy:a study of 548 patients[J].Zhonghua Fang She Zhong Liu Xue Za Zhi,2016,25(11):1172-6.]
[20]白文文,宋玉芝,乔永志,等.食管鳞癌SIB-IMRT疗效及预后因素分析[J].中华放射肿瘤学杂志,2018,27(6):570-5.[Bai WW,Song YZ,Qiao YZ,et al.Clinical efficacy and probnosis factors of simultaneous integrated boost intensity-modulated radiation therapr for esophageal sequamous cell carcinoma[J].Zhonghua Fang She Zhong Liu Xue Za Zhi,2018,27(6):570-5.]