Clinical outcomes and prognostic factors for patients with early esophageal squamous cell carcinoma treated with definitive radiation therapy alone
Clinical outcomes and prognostic factors for patients with early esophageal squamous cell carcinoma treated with definitive radiation therapy alone
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DOI：
10.1097/01.mcg.0000165662.49036.2e
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发表时间：
2005-07-01
影响因子：
2.9
通讯作者：
Nakano, T
中科院分区：
文献类型：
--
作者：
Ishikawa, H;Sakurai, H;Nakano, T
目标和背景：各机构早期食管癌的治疗方法存在很大差异。放射治疗被认为是该疾病的器官保留治疗的有效方式。本研究的目的是评估放射治疗对早期食管癌患者的效果和局限性。研究：受试者为 38 名接受过单纯放射治疗的 I 期 (T1N0M0) 食管鳞状细胞癌患者。 11 个肿瘤在粘膜层内进行评估，而 27 个肿瘤通过超声内镜检查显示粘膜下浸润。所有患者均使用 2 Gy 的常规每日分割剂量接受超过 60 Gy 的治疗。 20例患者再次接受近距离放射治疗，处方剂量为低剂量率10 Gy（5 Gy X 2次）（8例）和高剂量率9 Gy（3 Gy X 3次）（12例）。研究结果和预后因素，包括腔内近距离放射治疗的疗效。结果：5年病因特异性生存率和局部控制率分别为82.6%和86.3%。8例粘膜下癌患者出现复发，但粘膜癌患者未观察到复发。在本研究中，肿瘤长度是原因特异性生存的一个具有统计学意义的预后因素（P = 0.018），而肿瘤深度则趋于具有统计学意义（P = 0.073）。在 27 名粘膜下癌患者中，肿瘤长度对生存率也具有统计学意义（P = 0.032）。短肿瘤组和长肿瘤组的5年病因特异性生存率分别为85.7%和55.6%。另一方面，使用腔内近距离放射治疗对患者的生存没有显着影响。结论：放射治疗对于肿瘤长度小于5厘米的早期食管鳞癌非常有效，但对于肿瘤长度5厘米或以上的粘膜下癌，应考虑其他治疗方式，包括放化疗，特别是对于无法手术的患者。
Goals and Background: There are great differences between treatment methods for early-stage esophageal cancer in institutions. Radiation therapy has been considered to be an effective modality as organ-preserving treatment of the disease. The aim of this study is to assess the effect and limitation of radiation therapy on patients with early esophageal cancer.Study: The subjects were 38 patients with stage I (T1N0M0) squamous cell carcinoma of the esophagus who had received definitive radiation therapy alone. Eleven tumors were assessed within the mucosal layer, whereas 27 tumors showed submucosal invasion by examination using endoscopic ultrasound. All patients were treated with more than 60 Gy using a conventional daily fractionation dose at 2 Gy. An additional boost with brachytherapy was performed for 20 patients, and the prescribed doses were 10 Gy (5 Gy X 2 times) with low dose rate (8 patients) and 9 Gy (3 Gy X 3 times) with high dose rate (12 patients). Outcomes and prognostic factors, including the efficacy of intraluminal brachytherapy, were investigated.Results: The cause-specific survival rate and the local control rate at 5 years were 82.6 % and 86.3 %, respectively Recurrences were noted in 8 patients with submucosal cancer, but no recurrence was observed in patients with mucosal cancer. In the present study, tumor length was a statistically significant prognostic factor for cause-specific survival (P = 0.018) and tumor depth tended toward statistical significance (P = 0.073). In 27 patients with submucosal cancer, the tumor length was also statistically significant for the survival (P = 0.032). The 5-year cause-specific survival rates for the short tumor group and the long tumor group were 85.7 % and 55.6 %, respectively. On the other hand, the use of intraluminal brachytherapy had no significant effect on patient survival.Conclusion: Radiation therapy is very effective for early esophageal squamous cell carcinoma with tumor length less than 5 cm, but other treatment modalities, including chemoradiotherapy especially for inoperable patients, should be considered for submucosal cancer with a tumor length of 5 cm or more.