| Objective: The purpose of this study was to observe and compare the curative effect of concurrent chemoradiotherapy and radiotherapy alone for patients with esophageal carcinoma,and the effect of different dose factors on long-term survival of esophageal cancer,to explore the survival advantages,thus providing guideline for the treatment of esophagus cancer.Methods: A total of 1387 eligible patients suffered from esophageal carcinoma between July 2003 and March 2014 were retrospectively reviewed.The median age was 66 years(range 30~96 years): 861 males and 526 females.Non-operative staging for esophageal carcinoma: 110 patients were stageⅠ,344 were stage Ⅱ and 933 were stage Ⅲ.In the whole group,780 cases were treated with radiotherapy alone,302 cases were treated with concurrent chemoradiotherapy,305 cases were treated with sequential chemoradiotherapy.The radiotherapy was delivered in 1.8~2Gy per fraction,5 fractions per week,total dose of 50~70Gy(median,60Gy).Chemotherapy regimen was FP or TP.Observe different clinical characteristics(gender,age,tumor location,barium meal length,T stage,N stage,TNM stage,tumor volume of GTV,prescription dose)of radiotherapy alone group and concurrent chemoradiotherapy group,to discover whether there are differences of the long-term survival and living conditions between this two groups,discuss the effects of different dose groups on the prognosis of esophageal carcinoma.The prognosis of all correlative factors of all patients was analyzed by multivariate Cox regression model.Results:1 Among the 1387 patients,675 cases(48.66%)were complete remission(CR),663 cases(47.80%)were partial remission(PR),13 cases(0.94%)were no remission(NR).The 1-year,3-year,5-year and 10-year survival rates were 68.2%,36.1%,26.7% and 15.4%,respectively.Median survival times were 21 months.2 Of all the patients,780 cases were radiotherapy alone,302 cases were concurrent chemoradiotherapy,305 cases were sequential chemoradiotherapy.The differences of the clinical data between the radiotherapy alone group and concurrent chemoradiotherapy group were: gender,age,tumor location,N stage and prescription dose.Among them,the patients in the concurrent chemoradiotherapy group had more males,were more younger,more located on cervical and upper thoracic segments,smaller prescription dose,later N stage.3 The 1-year,3-year,5-year and 10-year survival rates of radiotherapy alone group were 64.7%,32.4%,22.4%,11.3%,respectively.Median survival times were 19 months.The 1-year,3-year,5-year and 10-year survival rates of sequential chemoradiotherapy group were 69.8%,36.1%,28.1%,19.5%,respectively.Median survival times were 21 months.The 1-year,3-year,5-year and 10-year survival rates of concurrent chemoradiotherapy group were 75.5%,45.7%,36.7%,24.1%,respectively.Median survival times were 28 months.χ2=25.442,P=0.000.Compare any two groups among the three groups,the long-term survival rate of sequential radiotherapy group was better than that of radiotherapy alone group,concurrent chemoradiotherapy group was better than that of sequential radiotherapy group,concurrent chemoradiotherapy group was better than that of radiotherapy alone group.4 According to the prescription dose,all patients were divided into three groups(<60Gy group,=60Gy group,>60Gy group).There were 138 patients in the group of <60Gy prescription dose group,811 patients in the group of =60Gy prescription dose group,438 patients in the group of >60Gy prescription dose group.There were significant differences in clinical characteristics such as gender,age,N stage,tumor volume of GTV,chemotherapy.Among them,<60Gy group had more female,older,larger GTV volume patients;>60Gy group had more patients in the period of later N stage;60Gy group had a higher proportion of concurrent chemoradiotherapy.5 The analysis of preferred radiotherapy dose:(1)Overall survival: prescription dose =60Gy group,>60Gy group were better than <60Gy group,but the former two groups had no difference.(2)The radiotherapy alone group: prescription dose =60Gy group and >60Gy group were better than <60Gy group;but the former two groups had no difference.(3)The concurrent chemoradiotherapy group: prescription dose 60 Gy was better than the prescription dose of less than 60 Gy and more than 60 Gy,was the best survival among the three groups,but the latter two had no difference.6 The factors that might affect the long-term survival of radiotherapy alone group were analyzed by multivariate analysis.The results showed that the prescription dose ≥60Gy was the only survivable protective factor,while the middle and lower esophageal cancer,later N stage,larger GTV volume,not reached CR were the risk factors for survival.7 The long-term survival in esophageal cancer patients through Cox regression multivariate analysis showed: radiotherapy dose,chemotherapy,age,location,N stage,GTV volume,the recent effect of esophageal cancer are independent prognostic factors of esophageal cancer patients.Further analysis showed: the female,radiotherapy dose,chemotherapy are the protective factors for the survival;and age >70 years,middle and lower esophageal cancer,later N stage,larger GTV volume,not reached CR were the risk factors for survival.Conclusions:1 The overall survival rates are significantly improved after applying chemotherapy,concurrent chemoradiotherapy has more advantages than sequential radiotherapy,but elderly patients should be cautious to apply concurrent chemoradiotherapy.2 Different radiotherapy doses have different effects on long-term prognosis of esophageal cancer patients: For radiotherapy alone group,do not recommend reducing the radiotherapy dose to below 60 Gy in the case of treatment plan security and endangering organ safety if there are no taboo factors.But for concurrent chemoradiotherapy group,the dose should not be pushed to above 60 Gy.3 The long-term survival rate of radiotherapy alone group is low,middle and lower esophageal cancer,later N stage,larger GTV volume,not reached CR are the risk factors for survival.4 The long-term survival in esophageal cancer patients through Cox regression multivariate analysis showed: female,radiotherapy dose ≥60Gy,applying chemotherapy can improve the long-term survival rate.That is,do not recommend to reduce the radiotherapy dose to 60 Gy below even applying chemotherapy.In addition,concurrent chemoradiotherapy was the protect factor of survival. |
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