PDF(Pubmed)
Abstract：
BACKGROUND: Many patients undergo dose reduction or early termination of chemotherapy to reduce chemoradiotherapy-related toxicity, which may increase their risk of survival. However, this strategy may result in underdosing patients with locally advanced esophageal squamous cell carcinoma (LA-ESCC). This study aimed to analyze the relationship between the relative dose intensity (RDI) and survival outcomes in patients with LA-ESCC.
METHODS: This retrospective study assessed patients with LA-ESCC (cT2N + M0, cT3-4NanyM0) receiving neoadjuvant chemoradiotherapy (NCRT) with curative-intent esophagectomy. The patients received 2 courses of paclitaxel plus carboplatin (TC) combination radiotherapy prior to undergoing surgery. During NCRT, RDI was computed, defined as the received dose as a percentage of the standard dose, and the incidence of dose delays was estimated (≥ 7 days in any course cycle). The best RDI cutoff value (0.7) was obtained using ROC curve. The Kaplan-Meier survival curves were compared using the log-rank test, the treatment effect was measured using hazard ratios (HR) and 95% confidence intervals (CI).
RESULTS: We included 132 patients in this study, divided into RDI < 0.7 and RDI ≥ 0.7 groups using cut-off value of 0.7. RDI grade was an independent prognostic factor for OS. Baseline demographic and clinical characteristics were well balanced between the groups. There was no evidence that patients with RDI < 0.7 experienced less toxicity or those with RDI ≥ 0.7 resulted in more toxicity. However, patients with RDI < 0.7 who were given reduced doses had a worse overall survival [HR 0.49, 95% CI 0.27-0.88, P = 0.015]. The risk of a lower RDI increased with a longer dose delay time (P < 0.001).
CONCLUSIONS: The RDI below 0.7 for avoiding chemoradiotherapy toxicity administration led to a reduction in the dose intensity of treatment and decreased overall survival.
METHODS: This retrospective study assessed patients with LA-ESCC (cT2N + M0, cT3-4NanyM0) receiving neoadjuvant chemoradiotherapy (NCRT) with curative-intent esophagectomy. The patients received 2 courses of paclitaxel plus carboplatin (TC) combination radiotherapy prior to undergoing surgery. During NCRT, RDI was computed, defined as the received dose as a percentage of the standard dose, and the incidence of dose delays was estimated (≥ 7 days in any course cycle). The best RDI cutoff value (0.7) was obtained using ROC curve. The Kaplan-Meier survival curves were compared using the log-rank test, the treatment effect was measured using hazard ratios (HR) and 95% confidence intervals (CI).
RESULTS: We included 132 patients in this study, divided into RDI < 0.7 and RDI ≥ 0.7 groups using cut-off value of 0.7. RDI grade was an independent prognostic factor for OS. Baseline demographic and clinical characteristics were well balanced between the groups. There was no evidence that patients with RDI < 0.7 experienced less toxicity or those with RDI ≥ 0.7 resulted in more toxicity. However, patients with RDI < 0.7 who were given reduced doses had a worse overall survival [HR 0.49, 95% CI 0.27-0.88, P = 0.015]. The risk of a lower RDI increased with a longer dose delay time (P < 0.001).
CONCLUSIONS: The RDI below 0.7 for avoiding chemoradiotherapy toxicity administration led to a reduction in the dose intensity of treatment and decreased overall survival.
摘要：
背景：许多患者接受剂量减少或提前终止化疗以减少放化疗相关的毒性，这可能会增加他们的生存风险。然而,这一策略可能导致局部晚期食管鳞状细胞癌(LA-ESCC)患者用药剂量不足.本研究旨在分析LA-ESCC患者的相对剂量强度（RDI）与生存结局之间的关系。
方法：这项回顾性研究评估了LA-ESCC（cT2N+M0，cT3-4NanyM0）患者接受新辅助放化疗（NCRT）联合根治性食管切除术。患者在手术前接受了2个疗程的紫杉醇加卡铂（TC）联合放疗。在NCRT期间，计算了RDI，定义为接受的剂量占标准剂量的百分比，并估计了剂量延迟的发生率(在任何疗程周期中≥7天).使用ROC曲线获得最佳RDI截止值(0.7)。使用对数秩检验比较Kaplan-Meier存活曲线，使用风险比(HR)和95%置信区间(CI)衡量治疗效果.
结果：我们纳入了132名患者，分为RDI<0.7和RDI≥0.7组，采用截断值0.7。RDI分级是OS的独立预后因素。两组的基线人口统计学和临床特征平衡良好。没有证据表明RDI<0.7的患者毒性较低或RDI≥0.7的患者毒性较高。然而,RDI<0.7且剂量减少的患者总生存期较差[HR0.49,95%CI0.27~0.88,P=0.015].RDI越低的风险随着剂量延迟时间越长而增加(P<0.001)。
结论：避免放化疗毒性给药的RDI低于0.7导致治疗剂量强度降低和总生存期降低。
方法：这项回顾性研究评估了LA-ESCC（cT2N+M0，cT3-4NanyM0）患者接受新辅助放化疗（NCRT）联合根治性食管切除术。患者在手术前接受了2个疗程的紫杉醇加卡铂（TC）联合放疗。在NCRT期间，计算了RDI，定义为接受的剂量占标准剂量的百分比，并估计了剂量延迟的发生率(在任何疗程周期中≥7天).使用ROC曲线获得最佳RDI截止值(0.7)。使用对数秩检验比较Kaplan-Meier存活曲线，使用风险比(HR)和95%置信区间(CI)衡量治疗效果.
结果：我们纳入了132名患者，分为RDI<0.7和RDI≥0.7组，采用截断值0.7。RDI分级是OS的独立预后因素。两组的基线人口统计学和临床特征平衡良好。没有证据表明RDI<0.7的患者毒性较低或RDI≥0.7的患者毒性较高。然而,RDI<0.7且剂量减少的患者总生存期较差[HR0.49,95%CI0.27~0.88,P=0.015].RDI越低的风险随着剂量延迟时间越长而增加(P<0.001)。
结论：避免放化疗毒性给药的RDI低于0.7导致治疗剂量强度降低和总生存期降低。
