Abstract：
BACKGROUND: This study compared outcomes in patients with inoperable esophageal squamous cell carcinoma (ESCC) undergoing curative-intent concurrent chemoradiotherapy (CCRT) with intensity-modulated radiotherapy (IMRT) versus intensity-modulated proton therapy (IMPT).
METHODS: The study encompassed a retrospective cohort analysis of patients with inoperable ESCC who underwent curative-intent CCRT from January 1, 2015, to December 31, 2020, with data sourced from the Taiwan Cancer Registry Database. In this study, both IMRT and IMPT delivered a total equivalent effective dose of approximately 5040 cGy in 28 fractions, accompanied by platinum-based chemotherapy administered as per established protocols. Multivariate Cox regression analyses were performed to assess oncologic outcomes, and statistical analyses were conducted, including inverse probability of treatment-weighted and Fine and Gray method for competing risks.
RESULTS: The observed risks of ESCC-specific and all-cause mortality were lower in patients treated with IMPT compared with those treated with IMRT, with adjusted hazard ratios (aHRs) of 0.62 (95% confidence interval [CI]: 0.58-0.70) and 0.72 (95% CI: 0.66-0.80), respectively. IMPT also reduced grade 2 radiation-induced side effects, such as pneumonitis, fatigue, and major adverse cardiovascular events, with aHRs (95% CI) of 0.76 (0.66-0.82), 0.10 (0.07-0.14), and 0.70 (0.67-0.73), respectively. However, IMPT was associated with an increased risk of grade 2 radiation dermatitis, with aHR (95% CI) of 1.48 (1.36-1.60). No substantial differences were found in the incidence of radiation esophagitis between IMPT and IMRT when adjusting for covariates.
CONCLUSIONS: IMPT seems to be associated with superiority over IMRT in managing patients with inoperable ESCC undergoing curative-intent CCRT, suggesting improved survival outcomes and reduced toxicity. These findings have significant implications for the treatment of ESCC, particularly when surgery is not an option.
METHODS: The study encompassed a retrospective cohort analysis of patients with inoperable ESCC who underwent curative-intent CCRT from January 1, 2015, to December 31, 2020, with data sourced from the Taiwan Cancer Registry Database. In this study, both IMRT and IMPT delivered a total equivalent effective dose of approximately 5040 cGy in 28 fractions, accompanied by platinum-based chemotherapy administered as per established protocols. Multivariate Cox regression analyses were performed to assess oncologic outcomes, and statistical analyses were conducted, including inverse probability of treatment-weighted and Fine and Gray method for competing risks.
RESULTS: The observed risks of ESCC-specific and all-cause mortality were lower in patients treated with IMPT compared with those treated with IMRT, with adjusted hazard ratios (aHRs) of 0.62 (95% confidence interval [CI]: 0.58-0.70) and 0.72 (95% CI: 0.66-0.80), respectively. IMPT also reduced grade 2 radiation-induced side effects, such as pneumonitis, fatigue, and major adverse cardiovascular events, with aHRs (95% CI) of 0.76 (0.66-0.82), 0.10 (0.07-0.14), and 0.70 (0.67-0.73), respectively. However, IMPT was associated with an increased risk of grade 2 radiation dermatitis, with aHR (95% CI) of 1.48 (1.36-1.60). No substantial differences were found in the incidence of radiation esophagitis between IMPT and IMRT when adjusting for covariates.
CONCLUSIONS: IMPT seems to be associated with superiority over IMRT in managing patients with inoperable ESCC undergoing curative-intent CCRT, suggesting improved survival outcomes and reduced toxicity. These findings have significant implications for the treatment of ESCC, particularly when surgery is not an option.
摘要：
背景：本研究比较了无法手术的食管鳞状细胞癌（ESCC）患者接受根治性同步放化疗（CCRT）和调强放疗（IMRT）与调强质子治疗（IMPT）的结果。
方法：该研究包括对2015年1月1日至2020年12月31日期间接受根治性CCRT的无法手术的ESCC患者进行回顾性队列分析，数据来自台湾癌症注册数据库。在这项研究中,IMRT和IMPT在28个部分中递送了大约5040cGy的总剂量，伴随铂类化疗按照既定方案进行。进行多变量Cox回归分析以评估肿瘤学结果，进行了统计分析，包括加权处理的逆概率和竞争风险的精细和灰色方法。
结果：与接受IMRT治疗的患者相比，接受IMPT治疗的患者观察到的ESCC特异性和全因死亡率风险较低，调整后的风险比（AHR）为0.62（95%CI：0.58，0.70）和0.72（95%CI：0.66，0.80），分别。IMPT还减少了2级辐射引起的副作用，比如肺炎，疲劳,MACE,AHR（95%CI）为0.76（0.66，0.82），0.10(0.07,0.14),和0.70（0.67，0.73）。然而,IMPT与2级放射性皮炎的风险增加有关，AHR(95%CI)为1.48(1.36,1.60)。调整协变量后，IMPT和IMRT之间放射性食管炎的发生率没有显着差异。
结论：在管理无法手术的ESCC患者进行根治性CCRT方面，IMPT似乎比IMRT更具优势，提示生存结局改善，毒性降低。这些发现对ESCC的治疗具有重要意义，特别是当手术不是一种选择。
方法：该研究包括对2015年1月1日至2020年12月31日期间接受根治性CCRT的无法手术的ESCC患者进行回顾性队列分析，数据来自台湾癌症注册数据库。在这项研究中,IMRT和IMPT在28个部分中递送了大约5040cGy的总剂量，伴随铂类化疗按照既定方案进行。进行多变量Cox回归分析以评估肿瘤学结果，进行了统计分析，包括加权处理的逆概率和竞争风险的精细和灰色方法。
结果：与接受IMRT治疗的患者相比，接受IMPT治疗的患者观察到的ESCC特异性和全因死亡率风险较低，调整后的风险比（AHR）为0.62（95%CI：0.58，0.70）和0.72（95%CI：0.66，0.80），分别。IMPT还减少了2级辐射引起的副作用，比如肺炎，疲劳,MACE,AHR（95%CI）为0.76（0.66，0.82），0.10(0.07,0.14),和0.70（0.67，0.73）。然而,IMPT与2级放射性皮炎的风险增加有关，AHR(95%CI)为1.48(1.36,1.60)。调整协变量后，IMPT和IMRT之间放射性食管炎的发生率没有显着差异。
结论：在管理无法手术的ESCC患者进行根治性CCRT方面，IMPT似乎比IMRT更具优势，提示生存结局改善，毒性降低。这些发现对ESCC的治疗具有重要意义，特别是当手术不是一种选择。
