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Postoperative Radiotherapy in Pathological T2-3N0M0 Thoracic Esophageal Squamous Cell Carcinoma: Interim Report of a Prospective, Phase III, Randomized Controlled Study.

胸段食管鳞癌病理 T2-3N0M0 术后放疗: 一项前瞻性、 ⅲ 期、随机对照研究的中期报告。

  • 影响因子:4.24
  • DOI:10.1634/theoncologist.2019-0276
  • 作者列表:"Deng W","Yang J","Ni W","Li C","Chang X","Han W","Zhou Z","Chen D","Feng Q","Liang J","Lv J","Wang X","Wang X","Deng L","Wang W","Bi N","Zhang T","Li Y","Gao S","Xue Q","Mao Y","Sun K","Liu X","Fang D","Wang D","Li J","Zhao J","Shao K","Li Z","Chen X","Han L","Wang L","He J","Xiao Z
  • 发表时间:2020-02-21
Abstract

BACKGROUND:The role of postoperative radiotherapy in pathological T2-3N0M0 esophageal squamous cell carcinoma is unknown. We aimed to evaluate the efficacy and safety of postoperative radiotherapy in patients with pathological T2-3N0M0 thoracic esophageal squamous cell carcinoma. MATERIALS AND METHODS:Patients aged 18-72 years with pathological stage T2-3N0M0 esophageal squamous cell carcinoma after radical surgery and without neoadjuvant therapy were eligible. Patients were randomly assigned to surgery alone or to receive postoperative radiotherapy of 50.4 Gy in supraclavicular field and 56 Gy in mediastinal field in 28 fractions over 6 weeks. The primary endpoint was disease-free survival. The secondary endpoints were local-regional recurrence rate, overall survival, and radiation-related toxicities. RESULTS:From October 2012 to February 2018, 167 patients were enrolled in this study. We analyzed 157 patients whose follow-up time was more than 1 year or who had died. The median follow-up time was 45.6 months. The 3-year disease-free survival rates were 75.1% (95% confidence interval [CI] 65.9-85.5) in the postoperative radiotherapy group and 58.7% (95% CI 48.2-71.5) in the surgery group (hazard ratio 0.53, 95% CI 0.30-0.94, p = .030). Local-regional recurrence rate decreased significantly in the radiotherapy group (10.0% vs. 32.5% in the surgery group, p = .001). The overall survival and distant metastasis rates were not significantly different between two groups. Grade 3 toxicity rate related to radiotherapy was 12.5%. CONCLUSION:Postoperative radiotherapy significantly increased disease-free survival and decreased local regional recurrence rate in patients with pathological T2-3N0M0 thoracic esophageal squamous cell carcinoma with acceptable toxicities in this interim analysis. Further enrollment and follow-up are warranted to validate these findings in this ongoing trial. IMPLICATIONS FOR PRACTICE:The value of adjuvant radiotherapy for patients with node-negative esophageal cancer is not clear. The interim results of this phase III study indicated that postoperative radiotherapy significantly improved disease-free survival and decreased local-regional recurrence rate in patients with pathological T2-3N0M0 thoracic esophageal squamous cell carcinoma compared with surgery alone with acceptable toxicities. The distant metastasis rates and overall survival rates were not different between the two groups. Adjuvant radiotherapy should be considered for pathologic T2-3N0M0 thoracic esophageal squamous cell carcinoma. Prospective trials to identify high-risk subgroups are needed.

摘要

背景: 术后放疗在食管鳞癌病理 T2-3N0M0 作用尚不清楚。本研究旨在评价胸段食管鳞癌病理 T2-3N0M0 术后放射治疗的有效性和安全性。 材料与方法: 年龄 18 ~ 72 岁,病理分期为 T2-3N0M0 食管鳞癌根治术后未接受新辅助治疗的患者。患者随机分为单纯手术或术后放疗,锁骨上野 50.4 Gy,纵隔野 56 Gy,共 28 次,疗程 6 周。主要终点是无病生存率。次要终点是局部区域复发率、总生存期和放射相关毒性。 结果: 从 2012年10月到 2018年2月,共有 167 例患者入选本研究。我们分析了 157 例随访时间超过 1 年或已死亡的患者。中位随访时间为 45.6 个月。术后放疗组 3 年无病生存率分别为 75.1% (95% 可信区间 [CI] 65.9-85.5) 和 58.7% (95% CI 48.2-71.5) 在手术组中 (风险比 0.53,95% CI 0.30-0.94,p =. 030)。放疗组局部区域复发率显著降低 (10.0% vs.手术组 32.5%,p =.001)。两组的总生存率和远处转移率无显著差异。与放疗相关的 3 级毒性发生率为 12.5%。 结论: 术后放疗可显著提高病理 T2-3N0M0 胸段食管鳞癌患者的无病生存率,降低局部区域复发率,毒性反应可接受。在这项正在进行的试验中,需要进一步的入组和随访来验证这些发现。 对实践的启示: 辅助放疗对淋巴结阴性食管癌患者的价值尚不清楚。这项 III 期研究的中期结果表明,与单纯手术相比,术后放疗可显著改善病理 T2-3N0M0 胸段食管鳞癌患者的无病生存率和降低局部-区域复发率。可接受的毒性。两组的远处转移率和总生存率无差异。胸段食管鳞癌病理 T2-3N0M0 应考虑辅助放疗。需要前瞻性试验来确定高危亚组。

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影响因子:2.69
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作者列表:["Li Y","Wang Z","Jin J","Zhu SX","He GQ","Li SH","Wang J","Cai Y"]

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影响因子:2.46
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