Background

The optimal radiation field of chemoradiation therapy (CRT) for stage I esophageal squamous cell carcinoma (ESCC) is unknown. This retrospective study compared efficacy and safety of two CRT modalities, involved field irradiation (IFI) and elective nodal irradiation (ENI), when treating patients with clinical stage I (T1bN0M0) ESCC.

Methods

Patients had received 60 Gy CRT concurrently with 5-FU and cisplatin between January 2000 and December 2012. The clinical target volume of IFI was limited to the primary tumor plus a 2-cm craniocaudal margin; that of ENI covered the primary tumor plus the field of regional lymph nodes.

Results

One hundred and ninety-five patients were selected (IFI group, 78; ENI group, 117). The 5-year overall, cause-specific and progression-free survival rates were 90.5%, 91.6% and 77.6% in the IFI group, and 72.5%, 88.3%, 57.9% in the ENI group, respectively. Of recurrent patients (n = 16 in the IF and n = 33 in the ENI groups) after achieving complete remission, 12 (75%) in the IFI group received definitive salvage therapy, 11 (33%) patients did in the ENI group. More patients died of diseases other than esophageal cancer in the ENI group (n = 29, 25%) than in the IFI group (n = 3, 3.8%). Multivariate analysis identified ENI (HR 3.63 [1.78–7.38], p < 0.001), age ≥ 70 (HR 2.65 [1.53–4.58], p < 0.001) and PS = 1 (HR 2.36 [1.33–4.18], p = 0.003) as poor prognostic factors for OS.

Conclusions

IF irradiation would be better than ENI for the patients with stage I ESCC who received definitive chemoradiotherapy.

中文翻译：

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T1bN0M0食管癌受累野放疗与择期淋巴结放疗联合同步化疗的比较。

背景

尚不清楚 I 期食管鳞状细胞癌 (ESCC) 放化疗 (CRT) 的最佳放射野。这项回顾性研究比较了两种 CRT 方式，包括场照射 (IFI) 和选择性淋巴结照射 (ENI)，在治疗临床 I 期 (T1bN0M0) ESCC 患者时的疗效和安全性。

方法

2000 年 1 月至 2012 年 12 月期间，患者接受了 60 Gy CRT 联合 5-FU 和顺铂治疗。ENI覆盖了原发肿瘤和区域淋巴结区域。

结果

选择了 195 名患者（IFI 组，78 名；ENI 组，117 名）。IFI组的5年总体、病因特异性和无进展生存率分别为90.5%、91.6%和77.6%，ENI组分别为72.5%、88.3%和57.9%。 在达到完全缓解后的复发患者（ IF组n = 16 和ENI 组n = 33）中，IFI 组有 12 名（75%）接受了根治性挽救治疗，ENI 组有 11 名（33%）患者接受了治疗。ENI 组 ( n  = 29, 25%) 中死于食管癌以外疾病的患者多于 IFI 组 ( n  = 3, 3.8%)。多变量分析确定 ENI（HR 3.63 [1.78-7.38]，p  < 0.001），年龄 ≥ 70（HR 2.65 [1.53-4.58]，p < 0.001) 和 PS = 1（HR 2.36 [1.33–4.18]，p  = 0.003）作为 OS 的不良预后因素。

结论

对于接受明确放化疗的 I 期 ESCC 患者，IF 照射将优于 ENI。