Clinical Study Of Intensity Modulated Radiation Therapy For Patients With Esophageal Cancer

Objective: To investigate the long term clinical result of three-dimen-sional conformal radiotherapy(3DCRT), intensity modulated radiation therapy(IMRT) for esophageal carcinoma,discussing the effect of correlative factorsto survival and local control, offering the reference for the application ofIMRT in treatment of esophageal carcinoma.Methods: From July2003to June2012,1366patients with esophagealcancer were eligible for the analysis. The median age was66years (range30-95years). There are848males and518females.1360patients with squam-ous carcinoma,6with adenocarcinoma. Non-operative staging for esophagealcarcinoma:124patients with stage I,363with stage II and879with stageIII.987patients were treated with3DCRT and379patients were treated withIMRT. Non-operative staging for esophageal carcinoma of3D-CRT group：89patients with stage I,245with stage II and653with stage III.Non-operativestaging for esophageal carcinoma of IMRT group:35patients with stage I,118with stage II and226with stage III.269patients of3D-CRT group weretreated by sequential or concurrent chemo-radiotherapy, and other718patientsreceived radiotherapy alone.170patients of IMRT group were treated bysequential or concurrent chemo-radiotherapy, and other209patients receivedradiotherapy alone. The radiotherapy was delivered in1.8-2Gy per fraction,5fractions per week,total dose of50.4-70Gy,(median,60Gy).We evaluated theshort term clinical result,side effect,the1-year,3-year and5-year local controlrates and survival rates, and analyzed long term survival of non-operativeTNM stages,tumor volumes,with the concurrent chemotherapy and radiationdoses.Results: The following rate was97.58%.Curative effect was evaluatedafter the treatment.The complete response rate of3D-CRT group was53.1% (482/908)and the partial response rate was45.7%(415/908),the overallresponse rate was98.8%.The complete response rate of IMRT group was44.1%(161/365)and the partial response rate was55.6%(203/365), the overallresponse rate was99.7%. The1-year,3-year and5-year local control rates of3D-CRT and IMRT group were73.90%,52.10%,49.70%;77.40%,60.60%,55.70%,(χ2=6.48, P=0.011), respectively.The1-year,3-year and5-yearsurvival rates of3D-CRT and IMRT group were69.20%、36.20%、24.00%;66.50%,35.00%,25.80%(χ2=0.014, P=0.905). The1-year,3-year and5-yearlocal control rates of3D-CRT and IMRT group with the patients oflower-thoracic lesion were71.4%、49.9%、45%and80.8%、64.9%、64.9%,(χ2=4.221,P=0.040), respectively.The1-year,3-year and5-year local controlrates of3D-CRT and IMRT group with the patients of without chemotherapywere73.2%,50.2%,45.6%和77.1%,60.5%,57.7%,(χ2=0.698, P=0.027), resp-ectttively.The1-year,3-year and5-year survival rates of3D-CRT and IMRTgroup with the patients of lower-thoracic lesion were68.10%、32.40%,22.60%和72.0%,44.70%,33.50%,(χ2=4.023,P=0.045),respectively.The ratesof irradiated esophagitis in the3D-CRT group and IMRT group were55.70%和73.6%,(χ2=49.957,P=0.000)and the rates of pneumonitis were13.2%和20.8%,(χ2=7.422,P=0.024).971patients died,and of them,396patients (40.8%)with local failure and recurrence,236patients (24.3%) with distant metastases.Conclusion: The IMRT treatment was an effective method for esopha-geal carcinoma.Comparing with3D-CRT, it may improve the local control ratemeanwhile the toxicities were not reduced. Curative effect and Overallsurvival rate were not improved.Local control failure was still the mail reasonof treatment failure,and the second reason was metastasis.