| Part ?A propensity-score analysis comparing long-term outcomes of primary radiotherapy and primary surgery for patients with cervical esophageal carcinoma[Purpose]This study aim to compare the long-term outcomes,failure patterns and larynx preservation rates of primary radiotherapy and primary surgery in patients with cervical esophageal carcinoma(CEC).[Materials and Methods]From January 2001 to December 2017,a total of 300 patients diagnosed as CEC in Cancer Hospital of Chinese Academy of Medical Sciences were retrospectively reviewed.Two hundred and five patients received primary radiotherapy(primary-RT group),and 95 patients received primary surgery(primary-S group).A 1:1 matched group was created by propensity score matching method to balance the differences.The Kaplan-Meier method was used to calculate overall survival(OS),local recurrence-free survival(LRFS),regional recurrence-free survival(RRFS)and distant metastases-free survival(DMFS).The Cox model was used for univariate and multivariate prognostic analysis.[Results]The median follow-up time was 95.6 months(95%confidence interval,82.1-109.1 months).Before matching,there were no statistical differences in 5-year OS(P=0.075),LRFS(P=0.050)and DMFS(P=0.146)between the primary-RT group and primary-S group.The 5-year RRFS of the primary-RT group was higher than that of the primary-S group(P=0.005).After matching,87 patients were well balanced in each group.The 5-year OS,LRFS,RRFS and DMFS were 35.2%and 33.2%(P=0.478),67.8%and 78.3%(P=0.097),78.1%and 61.0%(P=0.033)and 76.3%and 54.0%(P=0.032)in the primary-RT group and the primary-S group,respectively.Multivariate analysis showed that clinical stage(stage ?-?/?-?)was the only independent prognostic factor of OS(P=0.008).Tumor progression were occurred in 53.7%and 61.1%of patients in the primary-RT group and primary-S group.The major failure pattern was local recurrence(30.7%)for the primary-RT group and distant metastases(34.7%)for the primary-S group.The larynx preservation rate was 82.9%in the primary-RT group and 22.1%in the primary-S group.[Conclusions]Primary radiotherapy achieved similar OS,LRFS and higher RRFS,DMFS comparing primary surgery.Considering the long-term outcomes and the advantage of larynx preservation,radiotherapy is recommended as the primary treatment for CEC and salvage surgery could be used for those who were insensitive to preoperative radiotherapy.Part ?Long-term outcomes and failure patterns of definitive radiotherapy for cervical esophageal carcinoma[Purpose]To evaluate the long-term outcomes,failure patterns and prognostic factors of definitive radiotherapy in patients with cervical esophageal carcinoma(CEC).[Materials and Methods]We retrospectively reviewed the clinical data of 148 CEC patients who treated with definitive radiotherapy in Cancer Hospital of Chinese Academy of Medical Sciences from Jan 2001 to Dec 2017.The median radiation dose was 66Gy(59.4-70Gy)and 33.1%of patients received concurrent chemotherapy.The Kaplan-Meier method was used to calculate survival rates.The log-rank test was used for survival comparison and univariate prognostic analysis.The Cox model was used for multivariate prognostic analysis.[Results]The median follow-up time was 102.6 months.The median survival time,2-and 5-year overall survival(OS)were 22.7 months,49.9%and 28.3%.The median,2-and 5-year progression-free survival(PFS)were 12.6 months,35.8%and 25.8%.The 2-and 5-year locoregional recurrence-free survival(LRRFS)were 59.1%and 50.8%.The 2-and 5-year distant metastases-free survival(DMFS)were 74.6%and 65.9%.Multivariate analysis showed that EQD2>66Gy was the only independent prognostic indicator for OS(P=0.040).The median survival time and 5-year OS rate significantly improved in patients who received EQD2>66Gy than those who received<66Gy(31.2 months vs 19.2 months,40.1%vs 19.1%,P=0.027).A total of 87 patients(58.8%)developed tumor progression.There were 50(33.8%),23(15.5%)and 39(26.4%)patients developed local,regional recurrence and distant metastases,respectively.Eleven patients(7.4%)underwent salvage surgery,and the laryngeal preservation rate for entire group was 93.9%.[Conclusions]Definitive radiotherapy is an effective treatment for cervical esophageal carcinoma with the advantage of larynx preservation.Local recurrence was the major failure pattern.EQD2>66Gy was associated with improved overall survival.Part ?Prophylactic cranial irradiation in patients with limited-stage small-cell lung cancer without brain metastases reassessed by brain magnetic resonance imaging[Purpose]This study aimed to reevaluate the outcomes of prophylactic cranial irradiation(PCI)for patients with limited-stage small-cell lung cancer(LS-SCLC)who confirmed to be brain metastases-free by brain magnetic resonance imaging(MRI)after initial chemotherapy.[Materials and Methods]We retrospectively reviewed LS-SCLC patients treated by at least four cycles of chemotherapy and thoracic intensity-modulated radiotherapy between 2006 and 2014.All included patients achieved a complete or partial response(CR/PR)and were reassessed for brain metastases by MRI after initial chemoradiotherapy.The cumulative incidence of brain metastases was estimated using the Fine-Gray competing risks regression model.The overall survival(OS)and progression-free survival(PFS)were calculated using the Kaplan-Meier method.Univariate and multivariate analyses were performed using the Cox proportional hazards model.[Results]We enrolled 177 patients in this study,of which 79 were treated by PCI and 98 were not(non-PCI).The median follow-up was 76.0 months(95%confidence interval,71.2-80.8 months).The cumulative incidence of brain metastases in the PCI group was lower than in the non-PCI group(6.6%vs.30.0%at two years,12.2%vs.31.0%at five years,P=0.004).PFS in the PCI group was significantly higher than in the non-PCI group(45.3%vs.26.5%at five years,P=0.002).However,5-year OS of 48.8%and 39.2%in the PCI and non-PCI groups,respectively,was similar(P=0.255).In the multivariate analysis,treatment response(P<0.001)and PCI(P=0.038)were independent prognostic factors for PFS.Stratification analysis revealed that PCI did not improve PFS for patients with partial response to initial therapy(26.6%vs.19.7%at five years,P=0.234).Intracranial progression,extracranial progression,or both occurred in 2(2.5%),32(40.5%),or 9(11.4%)patients in the PCI group and 18(18.4%),47(48.0%),or 12(12.2%)patients in the non-PCI group,respectively.[Conclusions]PCI yielded a lower incidence of brain metastases and improved PFS but similar OS compared with non-PCI in LS-SCLC patients who were confirmed without brain metastases by MRI after initial chemotherapy.Patients with partial response did not gain PFS benefit from PCI. |
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