Preliminary Clinical Results Of Esophageal Carcinoma Treated With Target In Target Radiotherapy

Objective:1.To observe the short-term efficacy of target in target radiotherapy for the esophageal carcinoma,providing clinical reference for the radiotherapy of esophageal carcinoma. 2.To evaluate the toxicity of tomotherapy for the esophageal carcinoma, analysising of prognostic factors of radiotherapy.Methods:Retrospective analysis thirty-two patients with esophageal carcinoma admitted to our hospital from December 2010 to September 2013 were eligible to this study,treated with tomotherapy,radiotherapy plan is:PTV/GTV:60Gy/66-70 Gy,2.2-2.3Gy/f,5f/w,6 weeks.Follow-up every three months after the end of treatment,Term effect is three months after the end of treatment efficacy according to a recent objective evaluation criteria in solid tumors,normal tissue acute reaction by RTOG classification criteria to evaluate acute radiation injury, late reaction by RTOG/EORTG late radiation injury grading evaluation,survival rates and Local control rate were evaluated by Kaplan-Meier method,univariate analysis by Long-rank method,multivariate analysis by Cox regression model.Results:All patients were followed up until December 2014,2-38 months of follow-up time,The median follow-up time of 20 months,Follow-up rate is 96.9%.Term effect:three months after radiation therapy complete remission(CR) 23cases(71.9%),partial remission(PR) 7 cases(21.9%),stable(SD) 1 patients(3.1%), show progress(PD) 1 patients(3.1%),the total effective rate(CR + PR) was 93.8%;Cause of death:a total of 23 deaths, including 11 patients died of distant metastasis, 6 patients died of recurrence,3 patients died of gastrointestinal bleeding, 1 patient died of esophageal perforation, 2 patients died of lung infection.Local control rate and survivalrate: 1-year、2-year local control rate was 94.70%、88.90%;1-year、2-year survival rates were53.1%、30.0%,the longest one is 38 months,the shortest one is 2 months,the median follow-up time is 13months;Stage Ⅱhas 8 patients,1-year、2-year survival rates were62.5%、46.9%,the median follow-up time is 24 months;Stage Ⅲhas 11 patients,1-year、2-year survival rates were45.5%、34.1%,the median follow-up time is 13 months;Stage has 11 patients,1Ⅳ-year、2-year survival rates were38.5%、7.7%,the median follow-up time is 7 months;P=0.076,no significance. Radiation toxicity:Acute radiation esophagitis Level one in 11 cases(34.4%),Level two in 5 cases(15.6%);Acute radiation pneumonitis Level 1 in 2 cases(6.3%),Level 2 in 3 cases(9.4%);Cervical、the top thoracic、the middle thoracic、the lower thoracic acute radiation esophagitis rates is 3.33%、57.2%、57.2%、37.5%(P=0.337),acute radiation pneumonitis rates is 0、14.3%、28.6%、0(P=1.000);lesion length less than 5cm and more than 5cm acute radiation esophagitis rates is 46.7%、52.9%(P=1.000),acute radiation pneumonitis rates is 20% 、 11.8%(P=1.000).Ⅰdegree of bone marrow suppression in 12 patients(37.5%),Ⅱdegree of bone marrow suppression in 5 patients(15.6%), Ⅲdegree of bone marrow suppression in 1 patients(3.1%);gastrointestinal reactionsⅠdegree in 10 cases(31.3%), gastrointestinal reactions degree in two cases Ⅱ(6.3%), remission after treatment,nobody happened radioactive myelitis and pulmonary fibrosis; Analysis of prognostic factors:Univariate analysis showed that lesions(P =0.015), and lesion length(P=0.002) are prognostic factors for survival, the results were statistically significant;Multivariate analysis showed lesions(P=0.018), and lesion length(P=0.001) were independent prognostic factors for survival, the results were statistically significant, The gender, age, KPS score, weight loss, clinical stage, supraclavicular lymph node metastasis, abdominal lymph node metastasis were inrrelevent with prognosis.Conclusions:1.Target in target radiotherapy for the esophageal carcinoma,by increasing dose of target district,Local control and the recent effect were better, is an effective treatment for the patients with esophageal carcinoma.2.Acute radiation pneumonitis and acute radiation esophagitis were lower incidence,remission after treatment,regardlesss of the tumor location and length,late radiation-induced pulmonary fibrosis and radiation myelitis occurred, indicating that tomotherapy to protect normal tissues obvious advantages, safe and effective. 3. Lesions and lesion length are the independent prognostic factors after the treatment of target in target radiotherapy.