| Objective: The purpose of this study was to observe and compare the clinical characteristics and treatment relevant factors of patients of long-term survival with esophageal carcinoma treated with 3-dimensional conformal radiation therapy(3DCRT) and intensity modulated radiation therapy(IMRT) and to explore the survival advantages, thus providing guideline for the treatment of esophagus cancer.Methods: A total of 913 eligible patients suffered from esophageal carcinoma between July 2003 and December 2009 were retrospectively reviewed. The median age was 66 years(range 30~89 years): 564 males and 349 females. Non-operative staging for esophageal carcinoma: 68 patients were stage â… , 184 were stage â…¡ and 644 were stage â…¢. All patients were scanned with no distant metastases and were squamous carcinoma according to the pathological investigation. 263 patients underwent the treatment of chemotherapy, of which 174 did concurrent chemoradiotherapy. The radiotherapy was delivered in 1.8~2Gy per fraction, 5 fractions per week, total dose of 50~70Gy(median, 60Gy). All patients were divided into two groups according to their survival time: One was with lifetimes more than 60 months; the other was living less than 60 months. The variance of clinical characteristics such as gender, age, tumor localization, length, depth of invasion, nearby organ invasion, clinical stages and volume of tumor, short-term efficacy, treatment-related factors and acute toxicity between the two groups were compared. The prognosis of all correlative factors of all patients was analyzed by Cox multivariate model.Results:(1) Of all patients, the complete response rate was 54.33%(496/913) and the partial response rate was 44.47%(406/913). The 1-year, 3-year, 5-year, 7-year and 9-year local control rates were 77.1%, 51.7%, 46.5%, 41.5% and 37.1%, respectively. The 1-year, 3-year, 5-year, 7-year and 9-year survival rates were 72.5%, 34.8%, 23.8%, 16.6% and 12.1%, respectively. Median survival times were 21 months.(2) There were 217 patients in the group of long-term survival and 696 ones in the other group. The comparison of clinical characteristics of the two groups manifested distinct difference except for age and N stage. The group of long-term survival tended to have more female once, cancer with upper localization, shorter of length and transverse diameter, less invasion of nearby organs, earlier neoplasm staging and minor volume of tumor.(3) The method of radiotherapy and dose between the two groups were no significant difference. However, the long-term survival group had less time of treatment and more achieved complete response. The general average of GTV D100, D95, D90, V100, V95, V90 and PTV D100, D95, D90, V100, V95, V90 were higher in the group of long-term survival. Within the two groups, patients with radiotherapy dose of 60Gy/30 f were chosen. It is showed that GTVD100 and GTVD95 of the two sets were of statistically different.(4) The group of long-term survival had more patients treated with concurrent chemoradiotherapy. Among all patients received chemotherapy, the median number of cycle of chemotherapy for the two sides was 3 and 2. The group of superior survival tended to have more cycles of chemotherapy.(5) As to acute side effects, the group with shorter lifetime had a higher incidence of radiation pneumonia of level 4 and 5. However, the long-survival group had a higher prevalence of radiation esophagitis of level 1 to 3 and the other group had more patients without radiation esophagitis.(6) Single factor analysis of variance indicated gender, tumor localization, length of tumor, depth of invasion, nearby organ invasion, T stage, N stage, volume of gross tumor, GTV D100, GTV D95, PTV D100, chemotherapy, cycles of chemotherapy, acute radiation pneumonia, acute radiation esophagitis and short-term efficacy were all relevant factors of prognosis. Furthermore, the Multivariate analysis showed that tumor localization, TNM stage, volume of gross tumor, cycles of chemotherapy and short-time efficacy were independent prognostic factors.Conclusions:1 There is a distinct difference between the two kinds of lifetime groups of patients with esophageal carcinoma treated with radiotherapy. Several tumor-related factors are relevant to prognosis, among which tumor localization, TNM stage and volume of gross tumor are independent prognostic factors.2 The long-survival group has a shorter time of radiotherapy. Prescription dose has no difference in the two groups. The dose and volume parameters of GTV and PTV are superior in the group of long-survival,thereby the better treatment planning may contribute to the improvement of survival.3 The group of long-term survival has more patients treated with concurrent chemoradiotherapy and with more cycles of chemotherapy. Concurrent chemoradiotherapy and chemotherapy of more than two cycles may factors affect higher survival rates.4 The group of long-survival tends to has severer radiation esophagitis. Radiation esophagitis may relect a better treatment response. However, severe radiation pneumonia indicates poor prognosis. |
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