Acute toxicity of definitive chemoradiation in patients with inoperable or irresectable esophageal carcinoma
Acute toxicity of definitive chemoradiation in patients with inoperable or irresectable esophageal carcinoma
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DOI：
10.1186/1471-2407-14-56
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发表时间：
2014-01-31
期刊：
影响因子：
3.8
通讯作者：
van Laarhoven, Hanneke W. M.
中科院分区：
文献类型：
--
作者：
Mohammad, Nadia Haj;Hulshof, Maarten C. C. M.;van Laarhoven, Hanneke W. M.
背景：明确放化疗（dCRT）被认为是无法手术或不可切除食管癌患者的治疗目的。目前缺乏针对dCRT的急性毒性数据。方法：回顾性分析2006 - 2011年在单一三级中心接受6个周期紫杉醇50 mg/m2和卡铂AUC2联合放疗（50.4 Gy\1.8Gy）的dCRT治疗的患者。分析毒性、住院率和生存率。结果：127例患者接受了明确的放化疗。不可手术患者33例，不可切除患者94例，尽管不可手术患者肿瘤长度明显小于不可手术患者，但>= 3级毒性反应在不可手术患者中发生率（44%）明显高于不可手术患者（20%）（p < 0.05），不可手术患者住院发生率（39%）高于不可手术患者（22%）（p < 0.05），不可手术患者化疗周期中位数为5 （p = 0.01）。而对于无法切除的疾病患者，可以进行6个周期的治疗。复发率和生存率无显著差异。发生毒性>= 3级的比值比为2.6 (95% CI 1.0-6.4 p < 0.05)，不可手术患者的比值比为1.2 (95% CI 1.0-1.4 p = 0.02) / 10额外的微mol/l肌酐。结论：我们的数据显示，医学上不能手术的食管癌患者的终期放化疗的急性毒性比不能手术的食管癌患者更严重，并且主要发生在治疗的第5个周期。应在这一较为脆弱的群体中改善支持性护理。
Background: Definitive chemoradiation (dCRT) is considered curative intent treatment for patients with inoperable or irresectable esophageal cancer. Acute toxicity data focussing on dCRT are lacking.Methods: A retrospective analysis of patients treated with dCRT consisting of 6 cycles of paclitaxel 50 mg/m2 and carboplatin AUC2 concomitant with radiotherapy (50.4 Gy\1.8Gy) from 2006 through 2011 at a single tertiary center was performed. Toxicity, hospital admissions and survival were analysed.Results: 127 patients were treated with definitive chemoradiation. 33 patients were medically inoperable, 94 patients were irresectable, Despite of a significantly smaller tumor length in inoperable patients grade >= 3 toxicity was significantly recorded more often in the inoperable patients (44%) than in irresectable patients (20%) (p < 0.05) Hospital admission occurred more often in the inoperable patients (39%) than in the irresectable patients (22%) (p < 0.05) Median number of cycles of chemotherapy was five for inoperable patients (p = 0.01), while six cycles could be administered to patients with irresectable disease. Recurrence and survival were not significantly different. The odds ratio for developing toxicity >= grade 3 was 2.6 (95% CI 1.0-6.4 p < 0.05) for being an inoperable patient and 1.2 (95% CI 1.0-1.4 p = 0.02) per 10 extra micromol/l creatinine.Conclusions: Our data show that acute toxicity of definitive chemoradiation is worse in patients with medically inoperable esophageal carcinoma compared to patients with irresectable esophageal cancer and mainly occurs in the 5th cycle of treatment. Improvement of supportive care should be undertaken in this more fragile group.