Induction Radiation Therapy for Esophageal Cancer: Does Dose Affect Outcomes?
Induction Radiation Therapy for Esophageal Cancer: Does Dose Affect Outcomes?
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DOI：
10.1016/j.athoracsur.2018.09.064
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发表时间：
2019-03-01
影响因子：
4.6
通讯作者：
Puri, Varun
中科院分区：
文献类型：
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作者：
Semenkovich, Tara R.;Samson, Pamela P.;Puri, Varun
背景食管癌术前诱导放射治疗的剂量差异很大。我们调查了食管切除术后结果与诱导放射治疗剂量之间的关系。从国家癌症数据库中识别出接受诱导放射治疗（30 - 70戈伊），然后进行食管切除术的患者，并将其归类为低剂量（50.4戈伊）。比较围手术期结局和总生存率。亚组分析比较了两种常用剂量：45戈伊和50.4 Gy。从2004年到2014年，10,738名患者（84.7%）接受了标准剂量辐射，从2004年的69.7%增加到2014年的93.6%（p < 0.001），1,329名（10.5%）接受了低剂量辐射，608名（4.8%）接受了高剂量辐射。随着剂量的增加，观察到病理完全缓解率（pCR;低：11.7%，标准：16.2%，高：21.0%; p < 0.001）和分期降低率（低：52.0%，标准：56.4%，高：63.1%，p = 0.001）更高。在多变量分析中，与标准剂量相比，高剂量放疗与较高的30天死亡率相关（比值比[OR]，2.11; p < 0.001），而没有较高的降级或pCR的可能性。低剂量辐射与降级（OR，0.85; p = 0.04）和pCR（OR，0.67; p < 0.001）的可能性较低相关，但不会降低30天死亡率的风险。与45 Gy相比，50.4戈伊的剂量与pCR的可能性更高相关（OR，1.12; p = 0.04），且不影响30天死亡率。结论。高剂量诱导放疗（>50.4戈伊）与食管切除术后围手术期死亡率增加相关，而肿瘤反应无显著改善。低剂量辐射（
Background. Wide variation is seen in the dosage of preoperative induction radiation therapy for esophageal cancer. We investigated associations between outcomes after esophagectomy and dosage of induction radiation therapy.Methods. Patients undergoing induction radiation therapy (30 to 70 Gy), followed by esophagectomy, were identified from the National Cancer Database and classified as low (50.4 Gy). Perioperative outcomes and overall survival were compared. Subgroup analysis compared two common dosages: 45 Gy and 50.4 Gy.Results. From 2004 to 2014, 10,738 patients (84.7%) received standard-dose radiation, increasing from 69.7% in 2004 to 93.6% in 2014 (p < 0.001), 1,329 (10.5%) received low-dose radiation, and 608 (4.8%) received high-dose radiation. Higher rates of pathologic complete response (pCR; low: 11.7%, standard: 16.2%, high: 21.0%; p < 0.001) and downstaging (low: 52.0%, standard: 56.4%, high: 63.1%, p = 0.001) were observed as the dosage increased. On multivariable analysis, compared with standard-dose, high-dose radiation was associated with higher 30-day mortality (odds ratio [OR], 2.11; p < 0.001) without a higher likelihood of downstaging or pCR. Low-dose radiation was associated with lower likelihood of downstaging (OR, 0.85; p = 0.04) and pCR (OR, 0.67; p < 0.001) without lowering the risk of 30-day mortality. The dose of 50.4 Gy was associated with higher likelihood of pCR (OR, 1.12; p = 0.04), without affecting 30-day mortality, compared with 45 Gy.Conclusions. High-dose induction radiation (>50.4 Gy) is associated with increased perioperative death after esophagectomy, without a significant improvement in tumor response. Low-dose radiation (