Lancet子刊:放疗对晚期食管癌患者的吞咽困难无任何帮助!

2021-07-20 MedSci原创 MedSci原创

放疗对于食管癌患者,无论是存活时间还是吞咽困难,都无任何帮助。

食管癌是最常见的消化道肿瘤,全世界每年约有30万人死于食管癌。晚期食道癌患者的生存期只有3-6个月,除此外,大多数患者还不得不忍受吞咽困难的痛苦。目前插入自膨胀式金属支架(SEMS)是应对这种情况最典型的缓解形式,但此方法并不完美,常会发生吞咽困难的恶化,需要再次干预。外照射放疗(EBRT)曾被认为是缓解这一缺陷的方法之一。卡迪夫大学团队检验了EBRT辅助常规治疗的效果,发现EBRT并未带来任何益处,甚至提高了肿瘤出血的风险。该结果发表在Lancet Gastroenterol Hepatol上。

方法

 

该实验为一项多中心、开放标签、3期的随机对照试验,于英格兰、苏格兰和威尔士的癌症中心和急症护理医院进行。接受支架置入以治疗吞咽困难的食管癌患者(年龄>=16岁)被随机分配,接受常规治疗或EBRT(20Gy分5次或30Gy分10次)加常规治疗以进行支架置入后的护理。常规护理由当地的多学科团队提供。根据治疗中心,诊疗阶段(I,II,III,IV)、组织学特征(鳞状或非鳞状)和当地进行团队给予化疗的意图(是与否)通过最小化方法进行随机化。

主要关注结果为参与者吞咽困难恶化或死亡时间超过12周的人数的比例差异。实验采用欧洲癌症研究和治疗组织生活质量问卷-食管与胃模块(QLQ-OG25),吞咽困难恶化定义为得分降低>11分或发生与恶化等效的吞咽困难事件。次要结果包括生存率、生活质量(QoL)、发病率和成本效益。

 

结果

 

在2013年12月16日至2018年8月24日期间,来自23个英国医学中心的220名患者被随机分配,有意向接受治疗的人群(ITT,n=199)被分为常规治疗组(n=102)和EBRT组(n=97)。结果表明,放疗并未减少吞咽困难的恶化(常规治疗组36/74(49%)vsEBRT组34/75(45%),调整后的优势比为0.82,p=0.59)。存活时间未发现明显差异,接受常规治疗的存活时间中位数为19.7周(95% CI 14.4-27.7),接受EBRT的为18.9周(14.7-25.6)。第一次出现出血时间中位数,接受常规治疗的为49.0周,EBRT组为65.9周(调整后的亚劣势比比为0.52,p=0.038;n=199)。对于预先指定的QoL结果,未观察到时间与治疗的相互作用。未发现实验组在第一次支架并发症或再次干预事件发生的时间上存在差异。最常见的不良事件是疲劳,常规治疗组中19/102(19%)人出现疲劳,EBRT组22/97(23%人出现疲劳)。在成本效用分析中,EBRT相比常规治疗费用更高,效用更低。

表格 1:DDFS( 吞咽恶化人数-存活人数)和总存活人数

总结

 

对于患有晚期食道癌且接受了SEMS金属支架插入的患者,目前姑息放疗并没有带来任何额外的益处,也因此不应被当作有效手段提供。对于部分患者,姑息放疗更会加重肿瘤出血的风险。

 

参考文献:

Adamson D, Byrne A, Porter C et.al, Palliative radiotherapy after oesophageal cancer stenting (ROCS): a multicentre, open-label, phase 3 randomised controlled trial. Lancet Gastroenterol Hepatol. 2021 Apr;6(4):292-303. doi: 10.1016/S2468-1253(21)00004-2

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    2022-02-17 howi
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    2021-08-11 xxh0379

    “第一次出现出血时间中位数,接受常规治疗的为49.0周,EBRT组为65.9周(调整后的亚劣势比比为0.52,p=0.038;n=199)。”相同研究的相同数据,此句的解读与2月份那篇文章的解读似乎不太一样。

    0

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  5. [GetPortalCommentsPageByObjectIdResponse(id=1820954, encodeId=d9c01820954dc, content=<a href='/topic/show?id=e89410109e51' target=_blank style='color:#2F92EE;'>#食管癌患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101097, encryptionId=e89410109e51, topicName=食管癌患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=55683, createdName=仁医06, createdTime=Tue Mar 29 12:22:38 CST 2022, time=2022-03-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1831249, encodeId=50561831249aa, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Thu Feb 17 06:22:38 CST 2022, time=2022-02-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1007118, encodeId=d966100e118fa, content=“第一次出现出血时间中位数,接受常规治疗的为49.0周,EBRT组为65.9周(调整后的亚劣势比比为0.52,p=0.038;n=199)。”相同研究的相同数据,此句的解读与2月份那篇文章的解读似乎不太一样。, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=47ca5008954, createdName=xxh0379, createdTime=Wed Aug 11 22:51:38 CST 2021, time=2021-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1318630, encodeId=9f021318630cd, content=<a href='/topic/show?id=25eb391692f' target=_blank style='color:#2F92EE;'>#吞咽困难#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=39169, encryptionId=25eb391692f, topicName=吞咽困难)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5eee468, createdName=zxl729, createdTime=Thu Jul 22 09:22:38 CST 2021, time=2021-07-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1437645, encodeId=5cac143e645ab, content=<a href='/topic/show?id=0e311010591a' target=_blank style='color:#2F92EE;'>#食管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101059, encryptionId=0e311010591a, topicName=食管)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Thu Jul 22 09:22:38 CST 2021, time=2021-07-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1551857, encodeId=dd35155185edd, content=<a href='/topic/show?id=75d25989596' target=_blank style='color:#2F92EE;'>#晚期食管癌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=59895, encryptionId=75d25989596, topicName=晚期食管癌)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d93a14230733, createdName=lq1772, createdTime=Thu Jul 22 09:22:38 CST 2021, time=2021-07-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1034400, encodeId=46be1034400b6, content=顶刊就是不一样,质量很高,内容精彩!学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=goodbing, createdTime=Tue Jul 20 21:22:38 CST 2021, time=2021-07-20, status=1, ipAttribution=)]
    2021-07-22 zhouqu_8
  6. [GetPortalCommentsPageByObjectIdResponse(id=1820954, encodeId=d9c01820954dc, content=<a href='/topic/show?id=e89410109e51' target=_blank style='color:#2F92EE;'>#食管癌患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101097, encryptionId=e89410109e51, topicName=食管癌患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=55683, createdName=仁医06, createdTime=Tue Mar 29 12:22:38 CST 2022, time=2022-03-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1831249, encodeId=50561831249aa, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Thu Feb 17 06:22:38 CST 2022, time=2022-02-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1007118, encodeId=d966100e118fa, content=“第一次出现出血时间中位数,接受常规治疗的为49.0周,EBRT组为65.9周(调整后的亚劣势比比为0.52,p=0.038;n=199)。”相同研究的相同数据,此句的解读与2月份那篇文章的解读似乎不太一样。, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=47ca5008954, createdName=xxh0379, createdTime=Wed Aug 11 22:51:38 CST 2021, time=2021-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1318630, encodeId=9f021318630cd, content=<a href='/topic/show?id=25eb391692f' target=_blank style='color:#2F92EE;'>#吞咽困难#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=39169, encryptionId=25eb391692f, topicName=吞咽困难)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5eee468, createdName=zxl729, createdTime=Thu Jul 22 09:22:38 CST 2021, time=2021-07-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1437645, encodeId=5cac143e645ab, content=<a href='/topic/show?id=0e311010591a' target=_blank style='color:#2F92EE;'>#食管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101059, encryptionId=0e311010591a, topicName=食管)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Thu Jul 22 09:22:38 CST 2021, time=2021-07-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1551857, encodeId=dd35155185edd, content=<a href='/topic/show?id=75d25989596' target=_blank style='color:#2F92EE;'>#晚期食管癌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=59895, encryptionId=75d25989596, topicName=晚期食管癌)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d93a14230733, createdName=lq1772, createdTime=Thu Jul 22 09:22:38 CST 2021, time=2021-07-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1034400, encodeId=46be1034400b6, content=顶刊就是不一样,质量很高,内容精彩!学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=goodbing, createdTime=Tue Jul 20 21:22:38 CST 2021, time=2021-07-20, status=1, ipAttribution=)]
  7. [GetPortalCommentsPageByObjectIdResponse(id=1820954, encodeId=d9c01820954dc, content=<a href='/topic/show?id=e89410109e51' target=_blank style='color:#2F92EE;'>#食管癌患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101097, encryptionId=e89410109e51, topicName=食管癌患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=55683, createdName=仁医06, createdTime=Tue Mar 29 12:22:38 CST 2022, time=2022-03-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1831249, encodeId=50561831249aa, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Thu Feb 17 06:22:38 CST 2022, time=2022-02-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1007118, encodeId=d966100e118fa, content=“第一次出现出血时间中位数,接受常规治疗的为49.0周,EBRT组为65.9周(调整后的亚劣势比比为0.52,p=0.038;n=199)。”相同研究的相同数据,此句的解读与2月份那篇文章的解读似乎不太一样。, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=47ca5008954, createdName=xxh0379, createdTime=Wed Aug 11 22:51:38 CST 2021, time=2021-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1318630, encodeId=9f021318630cd, content=<a href='/topic/show?id=25eb391692f' target=_blank style='color:#2F92EE;'>#吞咽困难#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=39169, encryptionId=25eb391692f, topicName=吞咽困难)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5eee468, createdName=zxl729, createdTime=Thu Jul 22 09:22:38 CST 2021, time=2021-07-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1437645, encodeId=5cac143e645ab, content=<a href='/topic/show?id=0e311010591a' target=_blank style='color:#2F92EE;'>#食管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101059, encryptionId=0e311010591a, topicName=食管)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Thu Jul 22 09:22:38 CST 2021, time=2021-07-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1551857, encodeId=dd35155185edd, content=<a href='/topic/show?id=75d25989596' target=_blank style='color:#2F92EE;'>#晚期食管癌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=59895, encryptionId=75d25989596, topicName=晚期食管癌)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d93a14230733, createdName=lq1772, createdTime=Thu Jul 22 09:22:38 CST 2021, time=2021-07-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1034400, encodeId=46be1034400b6, content=顶刊就是不一样,质量很高,内容精彩!学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=goodbing, createdTime=Tue Jul 20 21:22:38 CST 2021, time=2021-07-20, status=1, ipAttribution=)]
    2021-07-20 goodbing

    顶刊就是不一样,质量很高,内容精彩!学到很多

    0

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