Analysis The Correlative Factors Of The Local Regional Failure After Definitive Intensity Modality Radiotherapy(IMRT) Of Esophageal Carcinoma

Objective:To explore the relation affect factor of local regional failure after definitive intensity modality radiotherapy(IMRT)of esophageal carcinoma,in order to provide the reference criteria for exactly evaluate the prognosis of esophageal carcinoma treated by radiotherapy.Methods:From January 2008 to December 2017,88 patients of esophageal carcinoma were respectively analyzed,which treated by definitive radiation therapy in The Fourth Hospital of Hebei Medical university.Compared and analyzed the data of before radiotherapy treatment and peripheral blood cells index.Use SPSS 21.0 statistical analysis software,Kaplan Meier method was used to calculate local regional control rate with every influencing factors.The COX regression model was used for multivariate analysis with the local control rates.Results:All the 88 patients were followed up to 31 December 2017,and the follow up rate was 92.3%.The total effective rate of the whole group was100%,including complete remission(CR)26.1%(23/88)and partial remission(PR)73.9%(65/88).In the whole group 1,3,5 years local regional control rate were 59.1%,14.8%and 6.8%,respectively,and the median local regional control time was 14.8 months.A series of factors,for example,the pretreatment intake,lesion length,T stage,N stage,TNM stage,irradiation range,the hemoglobin values before or after,the value of leukocyte before or after,and the value of lymphocyte before radiotherapy were the important effect factors for the local regional control by univariate analysis.According to the results of univariate analysis,founded the patients with higher levels of hemoglobin and the higher levels of albumin had the better local regional control rate than those patients which the lower levels of hemoglobin and albumin,and with a statistically significant(χ~2=7.842,P=0.005).The multivariate analysis showed T stage(OR=2.497,P=0.000),irradiation dose(OR=1.664,P=0.031),the pretreatment intake(OR=4.876,P=0.000),the level of hemoglobin values after radiotherapy(OR=0.407,P=0.000)were independent prognostic factors for local regional control in patients of esophageal carcinoma after definitive radiotherapy.Failure modality analysis:All 77 patients had experience local recurrence and lymph node metastasis after definitive radiotherapy,including 30 cases with elective lymph node irradiation(22 cases recurrence inside radiation fields,3 cases recurrence outside radiation fields,5 cases recurrence both inside and outside radiation fields)and 47 cases with involved-field irradiation(30 cases recurrence inside radiation fields,12 cases recurrence outside radiation fields,5 cases recurrence both inside and outside radiation fields).There was no statistical difference in the three recurrence patterns between the two groups(χ~2=3.025,P=0.220).furthermore there was also no statistical difference between the two recurrence pattern groups,including recurrence between inside radiation fields and non-inside radiation fields,outside radiation fields and non-outside radiation fields,both inside and outside radiation fields and non-both inside and outside radiation fields(χ~2=0.754,P=0.385;χ~2=2.816,P=0.093;χ~2=0.589,P=0.443,respectively).Conclusions:T stage,irradiation dose,pretreatment intake,the level of hemoglobin values after radiotherapy were independent prognostic factors for local regional failure in patients of esophageal carcinoma after definitive intensity modality radiotherapy.