Lymphocyte-Sparing Effect of Proton Therapy in Patients with Esophageal Cancer Treated with Definitive Chemoradiation.
Lymphocyte-Sparing Effect of Proton Therapy in Patients with Esophageal Cancer Treated with Definitive Chemoradiation.
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DOI：
10.14338/ijpt-17-00033.1
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发表时间：
2018
影响因子：
1.7
通讯作者：
Lin SH
中科院分区：
文献类型：
--
作者：
Fang P;Shiraishi Y;Verma V;Jiang W;Song J;Hobbs BP;Lin SH
评估质子束治疗（PBT）或调强放射治疗（IMRT）的放射治疗方式是否与接受食管癌确定性放化疗治疗的患者的淋巴细胞减少症相关。回顾性分析了2004年至2016年期间接受双模治疗的食管癌患者（n = 448）。根据关键患者和疾病因素，PBT治疗患者与IMRT治疗患者的倾向评分相匹配，并按临床疾病分期分层。在完成放疗后1个月内发生早期远处转移性疾病的患者被排除在外。单变量和多变量逻辑回归用于确定与4级淋巴细胞减少症风险增加相关的变量。多变量考克斯比例风险回归用于评估与总生存期、无病生存期和局部无复发生存期相关的因素。接受IMRT和PBT的患者（n = 220）在年龄、性别、分期、体能状态、肿瘤位置、组织学、肿瘤靶体积或诱导化疗方面没有差异。IMRT治疗与PBT治疗比较（比值比[OR]，2.13; 95%置信区间[95% CI]，1.19-3.81; P = .01），年龄增加（OR，1.039/年增加; 95% CI，1.003-1.076; P = 0.03），计划靶体积更大（OR，每增加1单位log（计划目标体积）3.47; 95% CI，1.67-7.21; P < .001），与4级淋巴细胞减少症风险增加相关。放射方式与食道下部肿瘤患者的淋巴细胞减少相关（P = 0.005），但与食道上部或中部肿瘤患者的淋巴细胞减少无关（P = 0.32）。在接受明确放化疗的食管癌患者中，PBT可降低重度治疗相关淋巴细胞减少症的风险，尤其是在食管下段肿瘤中。
To assess whether radiation treatment modality with proton beam therapy (PBT) or intensity-modulated radiation therapy (IMRT) is associated with lymphopenia in patients treated with definitive chemoradiation for esophageal cancer. Patients with esophageal cancer treated with bimodality therapy (n = 448) between 2004 and 2016 were retrospectively reviewed. Patients treated with PBT were matched by propensity score with those treated with IMRT, based on key patient and disease factors, and stratified by clinical disease stage. Patients who developed early, distant metastatic disease within 1 month of completing radiation were excluded. Univariable and multivariable logistic regression were used to identify variables associated with increased risk of grade 4 lymphopenia. Multivariable Cox proportional hazards regression was used to assess factors associated with overall survival, disease-free survival, and locoregional relapse-free survival. Patients who had IMRT and PBT matched by propensity score (n = 220) were not different with respect to age, sex, stage, performance status, tumor location, histology, tumor target volume, or induction chemotherapy. Treatment with IMRT, compared with PBT (odds ratio [OR], 2.13; 95% confidence interval [95% CI], 1.19–3.81; P = .01), increased age (OR, 1.039/y increase; 95% CI, 1.003–1.076; P = .03), and greater planning target volume (OR, 3.47 per 1-unit increase in log (planning target volume); 95% CI, 1.67–7.21; P < .001), was associated with increased risk of grade 4 lymphopenia. Radiation modality was associated with lymphocyte reduction in patients with tumors in the lower esophagus (P = .005) but not for those with tumors in the upper or middle esophagus (P = 0.32). In patients with esophageal cancer treated with definitive chemoradiation, PBT reduces the risk of severe, treatment-related lymphopenia, particularly in tumors of the lower esophagus.