Treatment Outcomes Of 817 Cases Of Esophageal Carcinoma Patients Treated With Three-dimensional Conformal Radiotherapy

Objective: To investigate the long term clinical result of three dimensional conformal radiotherapy (3DCRT) for esophageal carcinoma, discussing the effect of correlative factors to survival and local control, offering the reference for the application of 3DCRT in treatment of esophageal carcinoma.Methods: From July 2003 to December 2008, 817 patients with esophageal cancer were eligible for the analysis. The median age was 66 years(range 30～89 years). There are 491 males and 326 females. 792 patients with squamous carcinoma, 9 with adenocarcinoma, 13 with small cell carcinoma,2 with carcinoid tumor and 1 with undifferentiated carcinoma. Non-operative staging for esophageal carcinoma: 69 patients with stageⅠ, 168 with stageⅡand 590with stageⅢ. 152 patients were treated by concurrent chemo-radiotherapy, and the other 665 patients radiotherapy alone. 803 patients were treated with 3DCRT or intensity-modulated radiotherapy, and 14 patients were treated with 3DCRT followed by conventional radiotherapy. The radiotherapy was delivered in 1.8~2Gy per fraction, 5 fractions per week, total dose of 50～70Gy,(median, 60Gy). We evaluated the short term clinical result, side effect, the 1-year, 3-year and 5-year local control rates and survival rates, and analyzed long term survival of non-operative TNM stages, tumor volumes, with the concurrent chemotherapy and radiation doses.Results: The following rate was 95.96%. All patients completed the radiotherapy between 33 and 80 days (median, 44 days), and 83.8% completed in 49 days. Curative effect was evaluated after the treatment. The complete response rate was 52.0% (425/817) and the partial response rate was 37.7% (308/817), the overall response rate was 89.7%. The 1-year, 3-year and 5-year local control rates were 76.8%, 53.5%, 48.6%. The 1-year, 3-year and 5-year survival rates were 69.9%, 35.3% and 21.5%, respectively. Median survival time for the total group of patients was 21 months. 537 patients died, and of them, 219 patients (40.8%) with local failure and recurrence, 114 patients (21.2%) with distant metastases. TNM stage, tumor volume, radiation dose, the concurrent chemotherapy were analyzed, about influence on local control rates and survival rates. The results that :①For the group of stageⅠ,stageⅡand stageⅢ, 5-year local control rates were 54.0%, 56.2%,45.2%,χ~2=11.615 , P=0.003 ; and 5-year survival rates were 44.3%, 31.1%,17.1%,(χ~2=32.858 , P=0.000) , There were significant difference between groups.②For the patients whose volume of GTV <44.75cm~3 and≥44.75cm~3 the 1-year, 3-year, 5-year local control rates were 84.4%, 60.1%, 55.1% and 70.7%, 44.0%, 40.8% (χ~2=20.699,P=0.000), the 1-year, 3-year and 5-year survival rates were 78.3%, 47.0%, 28.8% and 64.4%, 23.0%, 13.7%,(χ~2=55.120,P=0.000).③For the two groups of concurrent chemo-radiotherapy and radiotherapy alone, 1-year,3-year and 5-year local control rates were 79.9%, 64.5%, 62.7% and 76.1%, 50.9%, 45.7%(,χ~2=6.359,P=0.012). There was not significant difference between two groups.④For the patients whose treatment dose of <55Gy,≥55~60Gy,≥60~65Gy and≥65Gy the 5-year survival rates were 28.7%, 24.9%, 21.5% and 19.0% (χ~2=0.043, P=0.837). There was not significant difference.The survival rates and local control rates of patients stage III, with radiation dose 60~65Gy, are superior to patients with radiation dose less than 60Gy, and the difference was significant between both groups. For the tumor volume less than 44.75cm~3 groups of concurrent chemo-radiotherapy and radiotherapy alone , the local control rates of 1-year, 3-year and 5-year were 91.3%, 72.9%, 57.8% and 79.4%, 57.0%, 53.3% respectively, (χ~2=5.224,P=0.022). The median survival time of two groups were 41 mouth and 29 month, the 1-year, 3-year and 5-year survival rates were 89.5%, 58.3%, 48.1% and 81.0%, 44.2%, 25.6%,(χ~2=3.890,P=0.049), respectively. Two groups' local control rates and survival rates showed a significant difference. For the tumor volume larger than 44.75cm~3, there was not significant difference whether local control rates or survival rates between groups of concurrent chemo-radiotherapy and radiotherapy alone.Conclusions: The 3DCRT treatment was an effective method for esophageal carcinoma. Comparing with the historical data, it may improve the local control rate and overall survival rate to some extent. TNM staging and tumor volume are the important factors for the long-term survival. For patients of stageⅢ, 60 ~ 65Gy is more appropriate radiation doses.The addition of concurrent chemo-radiotherapy could improve local control rates of patients, and also could increase the survival of patients with tumor volume less than 44.75cm~3. However, local control failure was still the mail reason of treatment failure, and the second reason was metastasis.