| Objective:To explore the value of elective nodal prophylactic irradiationin esophageal carcinoma receiving definitive radiotherapy,we compare thelocal control rate,survival rate,the failure model and acute toxicity betweenpatients receiving elective nodal prophylactic irradiation and involved-fieldirradiation.Methods and materials:From Jan.2006to Dec.2012,245patients ofesophageal carcinoma were respectively analysed,which treated by definitiveradiation therapy in our hospital.One hundred and twenty-six patients receivedelective nodal prophylactic irradiation(ENI),the other119patients receivedinvolved-field irradiation(IFI).There were160males and85females.And229patients were squamous carcinoma,16patients were non-squamouscarcinoma.In245cases,there were53patients in stage Ⅰ,68in stageⅡ a nd124in stage Ⅲ.104patients received both radiotherapy and chemotherapy,andother141patients received radiotherapy alone.The relationship betweenprognosis and such factors as:radiation region,gender,age,pathologicaltype,tumor site,length of barium meal, the biggest CT diameter,invasion ofesophageal lesion,gross tumor volume, clinical T,N,TNMstage,chemotherapy,cycles of chemotherapy,were analyzed by univariate andmultivariate statistical methods.Failure patterns were analyzed aftertreatment.Local regional failure included esophagus uncontrol or recurrenceand regional lymph nodes failures.Distance metastases included distant organmetastases and distant lymph node metastases.Count data were analyzed bychi-square test and t test.Survival analysis was performed by the Kaplan-Meiermethod,and differences between the group were analyzed using the log-ranktest.Univariate and multivariate analysis for the prognosis of patients.The failure time was calculated from the start of the radiation treatment.Results:All the245patients were followed to November2013,and thefollowing rate was95.1%. All patients accomplished the radiation therapy.Thecomplete response rate was30.6%,the partial response rate was69.0%, noresponse rate was0.4%,and the overall response rate was99.6%.Theshort-term effect of ENI group was better than that of IFI group (χ2=4.245,P=0.039). The1,3,and5years local control rate were65.4%,44.4%,and39.5%respectively.The1,3,and5years overall survival rate were76.3%,36.7%,and21.3%respectively.The1,3,and5years overall non-distance metastasissurvival rate were67.3%,34.8%,and20.1%respectively.The univariatestatistics showed that radiation region,lesion length of barium meal,the biggestCT diameter,invasion of esophageal lesion,gross tumor volume,clinical T andTNM stage were the important influencing factors to local control,and lesionlength of barium meal,the biggest CT diameter,invasion of esophageallesion,gross tumor volume,clinical T,N,TNM stage,chemotherapy and cyclesof chemotherapy were the prognositic factors of overall survival.Lesion lengthof barium meal,the biggest CT diameter,invasion of esophageal lesion,grosstumor volume,clinical T,N,TNM stage were influencing factors of thenon-distance metastasis survival.The multivariate statistics showed thatclinical T stage,cycles of chemotherapy,and radiation region were theindependent factors to the local control.Clinical T,N stage,cycles ofchemotherapy were independent factors to the overall survival.Cycles ofchemotherapy,radiation region,clinical N stage were independent factors to thenon-distance metastasis survival.One hundred and sixty-three patients developed failure after treatment.Simple regional failure was observed in92patients.Simple distant metastaseswas observed in36patients.Both regional failure and distant metastases wasobserved in35patients. The1,3,and5years total failure rate of ENI group andIFI group was35.4%,62.5%,69.0%,46.5%,71.5%,81.5%respectively(χ2=4.402,P=0.036).The1,3,and5years regional failure rate of ENI and IFIgroup were29.9%,48.4%,50.0%and39.6%,62.1%,71.4%respectively (χ2=8.638,P=0.003).The1,3,and5years local lesion of esophageal failure rateof ENI and IFI group were26.7%,43.7%,45.6%and37.0%,55.5%,66.4%respectively (χ2=7.860,P=0.005).The1,3,and5years regional lymph nodesfailure rate of ENI and IFI group were6.4%,10.6%,10.6%and10.7%,22.0%,31.4%respectively (χ2=5.408,P=0.020).The1,3,and5yearsdistant metastases rate of ENI and IFI group were15.4%,30.7%,46.2%and21.1%,37.2%,45.1%respectively (χ2=0.072,P=0.789).Between ENI and IFIgroups,there was no statistical difference of≥2grade acute radiationesophagitis and of≥2grade acute radiation pneumonia.Conclusions:(1)The elective nodal prophylactic irradiation of esophageal carcinomareceiving definitive treatment could reduce regional failures and improve thelocal control.Combining with the chemotherapy,it could also increase the longterm survival.(2)The multivariate statistics showed that clinical T stage,cycles ofchemotherapy,and radiation region were the independent factor to localcontrol,and clinical T,N stage,cycles of chemotherapy were independentprognosis factors to overall survival.(3)The elective nodal prophylactic irradiation really decreased theregional failure,which was not related to the total priscription dose.It’spossible that extention of radiation field may contribute to therapeutic effectof early stage esophageal carcinoma. |
PDF Full Text Request