Salvage treatment for lymph node recurrence after radical resection of esophageal squamous cell carcinoma
Salvage treatment for lymph node recurrence after radical resection of esophageal squamous cell carcinoma
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DOI：
10.1186/s13014-019-1377-y
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发表时间：
2019-09-18
影响因子：
3.6
通讯作者：
Gu, Wendong
中科院分区：
文献类型：
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作者：
Chen, Jie;Yin, Wenming;Gu, Wendong
背景食道癌根治术后区域淋巴结复发患者的治疗效果较差。目前，区域淋巴结复发尚无标准的治疗方法，其预后危险因素尚不清楚。本研究对83例食管鳞癌根治术后区域淋巴结复发患者进行了回顾性分析。目的：评价保存性放疗联合化疗的临床疗效及影响预后的因素。方法对83例食管鳞癌根治术后区域淋巴结复发患者的生存率及预后因素进行回顾性分析。所有患者均接受放射治疗，其中74例接受体积调节弧形放射治疗(VMAT)，9例接受三维适形放射治疗(3DCRT)，采用常规分割方案，剂量分布范围为50.4~66.2GY(中位剂量60GY)。单纯放疗41例，放疗加化疗42例，同期化疗方案除4例5-氟尿嘧啶加铂(FP)或紫杉醇加铂(TP)外，其余均以铂或氟尿嘧啶为主。结果中位随访时间为24(9~75)个月。1、2、3、5年的总生存率分别为83.0%、57.1%、40.1%、35.1%。中位总生存期(OS)为18(5~75)个月。单纯放疗组和同步放化疗组3年生存率分别为47.5%和41.9%(P=0.570)，有效率(CR+PR)分别为73.2%和91.4%。OS的多变量分析发现，年龄(在年轻患者中更差，p=0.034)与疾病预后显著相关。常见的不良反应为食管炎、中性粒细胞减少症和贫血。18%的患者出现3级毒性反应，无治疗相关死亡。结论对食管鳞癌根治性切除术后的淋巴结复发，放疗加或不加化疗是一种有效、可行的挽救治疗方法。
Background Patients with regional lymph node recurrence after radical resection of esophageal cancer have poor therapeutic outcomes. Currently, there is no standard treatment for regional lymph node recurrence, and its prognostic risk factors are not well-understood. This study retrospectively analyzed 83 patients with postoperative regional lymph node recurrence after radical resection of esophageal squamous cell carcinoma. The aim was to evaluate the clinical efficacy and prognostic factors of salvage radiotherapy with or without chemotherapy in these patients. Methods The survival and prognostic factors of 83 patients with esophageal squamous cell carcinoma with regional lymph node recurrence after radical surgery were retrospectively analyzed. All patients underwent radiotherapy, of which 74 patients received volumetric modulated arc therapy (VMAT), 9 patients received three-dimensional conformal radiation therapy (3DCRT), administered using a conventional segmentation protocol with a dose distribution range of 50.4-66.2Gy (median dose of 60Gy). In total, 41 patients received radiotherapy alone, 42 received radiotherapy combined with chemotherapy, and the concurrent chemotherapy regimen was mainly composed of either platinum or fluorouracil monotherapy, except for 4 patients who were given 5-fluorouracil plus platinum (FP) or paclitaxel plus platinum (TP). Results The median follow-up time was 24 (range, 9-75) months. The overall survival (OS) rates at 1 year, 2 years, 3 years, and 5 years were 83.0, 57.1, 40.1, and 35.1%, respectively. The median overall survival (OS) time was 18 (range, 5-75) months. The 3-year survival rate was 47.5% in patients with radiation alone and 41.9% in patients receiving concurrent chemoradiotherapy(p = 0.570), while the response rate (CR + PR) in those two groups was 73.2 and 91.4%, respectively. By multivariate analysis of OS, age (worse in younger patients, p = 0.034) was found to be significantly associated with disease prognosis. The commonly toxicities were esophagitis, neutropenia and anemia. 18% patients experienced grade 3 toxicity and no treatment-related death occurred. Conclusions These results of this retrospective analysis suggest that radiotherapy with or without chemotherapy is an effective and feasible salvage treatment for lymph node recurrence after radical resection of esophageal squamous cell carcinoma.