Clinical Research Of 3-Dimensional Radiotherapy For Esophageal Carcinoma

Objective To summarize the outcomes and prognostic factors of three-dimensional radiotherapy (3D-CRT and IMRT) for esophageal carcinoma in our institute.Methods Five hundred ninety-two patients received radiotherapy for esophageal carcinoma (123 with 3D-CRT,469 with IMRT) from Jan 2002 to Mar 2012. Three hundred sixty patients received radiotherapy alone and 232 patients received radiotherapy and chemotherapy. The endpoints were overall survival (OS), progression-free survival (PFS). Kaplan-Meier analysis was used to calculate endpoints, the log-rank test for univariate analysis, and Cox model multivariate analysis to identify independent prognostic factors.The median dose was 60Gy.Concurrent chemotherapy was mainly used with paclitaxel plus Platinum weekly program-oriented. Sequential chemotherapy was mainly used with paclitaxel or fluorouracil plus Platinum 3 week programme.Results The number of samples at 3 and 5 years were 142 and 53.The 1-year OS, PFS were 65.3%,52.1%; the 3-year OS, PFS were 34.0%,28.0%; and the 5-year OS, PFS were 23.5%,19.6%. The median OS was 20 months (95%CI:17.9-22.1 months) and the median PFS was 14 months (95%CI:11.8-16.2 months). Univariate analysis indicated that sex, N-stage, M-stage, TNM stage, radiotherapy dose, weight loss before treatment, smoking, and drinking affected OS and PFS (P=0.002/0.000;0.000/0.000;0.001/0.000; 0.000/0.000; 0.000/0.000;0.024/0.026;0.009/0.005;0.000/0.000). The independent prognostic factors for better OS and PFS were early clinical TNM stage, high radiotherapy dose, and female sex (P=0.000/0.000;0.000/0.001;0.036/0.027).Conclusions The results of esophageal carcinoma patients treated with 3DRT with or without chemotherapy were promising. Clinical TNM stage, radiotherapy dose and sex were the independent prognostic factors for OS and PFS. Early TNM stage, high radiotherapy dose, and female sex were independently associated with better OS and PFS.Objective To compare the survival of radiotherapy alone with concurrent chemoradiotherapy for non-surgical esophageal carcinoma.Methods 480 Patients with esophageal squamous cell carcinoma were treated with definitive 3D radiotherapy with or without chemotherapy in our institute between 2002 and 2012. Of the 296 matched patients,148 were in each group.They were analyzed after matched with propensity score matched method.Results The number of samples were 58,48 and 58,52 at 3 years and 5 years on 3DRT and CCRT groups.The 3- and 5-years overall survival rate were 32.6% and 22.1% for 3DRT versus 35.1% and 26.5% for C+3DRT,respectively(P=0.463).The 3- and 5-years progression-free survival rate were 27.8% and 19.8% for 3DRT versus 30.7% and 25.8% for CCRT,respectively(P=0.637). On subgroup analysis, CCRT did not improve 5-years OS and PFS of 60-70Gy group (OS:25.3% and 25.6%, P=0.833; PFS:25.2% and 22.7%, P=0.999),CCRT could not reduce the hematogenous metastasis (24.1% and 23.4%, P=0.899).CCRT improved 5-years OS and PFS of 50.0-59.9Gy group (OS:32.3% and 12.0%, P=0.030; PFS:24.1% and 10.6%, P=0.087). In 3DRT alone group,5-years OS and PFS were significantly better in 60-70Gy group than 50.0-59.9Gy (P=0.024, P=0.041).In CCRT group,5-years OS and PFS favored 50.0-59.9Gy group, but the difference with 60-70Gy was insignificant (P=0.791, P=0.984). Acute toxicities of CCRT were more than 3DRT, major toxicities were esophagitis and leucopenia (P<0.001,0.005), which could be tolerated.Conclusions For non-surgical esophageal carcinoma, radiotherapy dose combined with chemotherapy should properly reduce.60-70Gy 3D radiotherapy alone could achieve promising survive, which need to be confirmed by prospective studies.Objective To retrospectively analyze the survive of different treatment methods for clinical stage III thoracic esophageal squamous cell carcinoma(TESCC) with the method of Propensity Score Matching(PSM), and comprare their outcomes.Methods From 2004 to 2009,616 patients with clinical stage Ⅲ TESCC underwent radical treatment were eligible for analysis. Patients were grouped to surgery (n= 469) with (n= 133) or without postoperative IMRT (n=336) and radiotherapy (n=147) with (n=34) or without concurrent chemotherapy (n=113).294 patients were enrolled after PSM. Postoperative radiotherapy applied via IMRT with a median total dose of 60Gy. The median total dose of radiotherapy group was 60Gy.The Kaplain-Meier method was used to calculate the survival rates, and the log-rank test was used for survival difference between groups analysis. Chi-squre test was used for difference and failure pattern between groups analysis.Results The last follow-up time was Jan 2015,58 patients was lost to follow-up,the follow-up rate was 90.6%.234 and 149patients were followed to at 3 and 5 years respectively. The 1-,3- and 5-year overall survival (OS) rates and event free survival(EFS) rates for all the patients were 73.0%,40.8%,31.8% and 59.9%,34.3%, 26.4% respectively.After match the 5-year OS rates of radiotherapy group and surgery group had significant difference (25.1% vs.33.8%, χ2= 5.639, P= 0.018), the 5-year EFS rates of two groups had not significant difference(19.4% vs.27.5%, χ2=2.161, P= 0.142). The 5-year OS rate of radiotherapy alone and surgery alone had significant differcence (OS:22.6% vs.32.7%, χ2=4.588, P=0.032),5-yr EFS rate was opposite (χ2= 1.232, P=0.267). OS rate of T4 patients in radiotherapy group and surgery group had no significant difference (NO:42.4% vs.47.6%,% χ2=0.587, P=0.444; N1:25.0% vs.35.4%, χ2= 1.815, P=0.178); OS rate of T3N1M0 patients in two groups had significant difference (21.8% vs.31.0%,χ2= 4.655, P=0.031). The 5-year OS and EFS rates of concurrent chemoradiotherapy and postoperative IMRT both had no significant differcence (OS:33.0% vs.36.1%,χ2=0.697, P=0.404; EFS:χ2=0.606, P= 0.436).The unspecified death of 19 patients left 284patients for a study of site and cause of failure. Treatment failure occurred in 168 patients with the total recurrence (progression) rate 57.1%. The main failure pattern of radiotherapy group was local failure (30.6%), which had significant difference comparision with surgery group (2.2%, P<0.001). The main failure pattern of surgery group were regional (27.0%) and distant lymph node failure (19.0%), which had significant difference comparision with radiotherapy group (5.4%,4.1%, P< 0.001, P< 0.001). The blood metastatis rate of two groups had not significant difference (23.8% vs.29.9%, P=0.245).Conclusions Surgery and 3DRT were the optimized choice to treatment for the patients with resectable clinical stage Ⅲ TESCC(including T3N1M0/T4N0-1M0). Radical 3DRT also has better efficacy for the patients with clinical stage Ⅲ TESCC who were non-surgery or refused sugery.