| Objective: To compare therapy effect between patients with esophageal carcinoma received radical radiation and chemoradiotherapy for local control,progression-free survival,and survival rate.To esplore patients the factors with influencing therapy between the two groups,then to achieve the optimal treating regimen for different stage and different physical condition.Methods: From Jan.2005 to Dec.2012,701 patients of esophageal carcinoma were retrospectively analysed.Of all the patients 469 patients,received radical radiotherapy and the other 232 patients received chemoradiotherapy base of platinum respectively.ALL patients were confirmed by pathology,670 were squamous carcinoma,and the other 31 were non-squamous carcinomar.According to the nor-surgical clinical staging of 2004 edition standard,there were 15 patients in Stage I,233 in stage II,309 in stage III,and 144 patients in stage IV.Observe short-term effects,and 1,3,5years of local control rate,progression-free survival and overall survival between the two geoups,and analyze factors related to prognosis(gender,age,pathological type,lesion length,largest diameter of lesion,T stage,N stage,clinical TNM stage,gross tumor volume,irradiated fields,dose of radiotherapy,radiotherapy regimen(3-DCRT or IMRT),remedial model(radical radiation or chemoradiotherapy),number cycles of chemotherapy,.Kaplan-Meier method was used to analyze the survival and log-rank test was used to evaluate the differences between the two groups.Cox regression model was used to analyze the prognostic factors.the beginning date was from the first day of the treatment.Results:(1)The effect and influencing factors of 701 patients of esophageal carcinoma: All patients were followed up to February 2016,and the rate of follow-up was 97.7%.All patients accomplished the plan of their therapies,and the complete response rate was 27%,the partial response rate was 68.3%,no response rate was 4.7% and the overall response rate was 95.3%.The short-term effect of patients received chemoradiotherapy was superior to that of patients received radical radiotherapy,but it was not the difference statistically(χ2=5.292,P=0.071).The 1,3,and 5 years of local control rate were 71.0%,46.1%,and 39.2% respectively,and 1,3,5 years the progression-free survival rate were 60.6%、30.3%、17.8%,respectively;and 1,3,5 years of the overall survival rate were 72.8%,32.6%,18.1% respectively.The univariate analysis showed that lesion length,largest diameter of lesion,N stage and clinical TNM stage,gross toumor volume and radiotherapy regimen were the important influencing factors to local control;lesion length and largest diameter of lesion,T stage,N stage,and clinical TNM stage,and gross toumor volume were the great influence factors of the progression-free survival;lesion length and largest diameter of lesion,T stage,N stage,and clinical TNM stage,gross toumor volume and irradiated fields were the important prognosis factors of overall survival.The Cox proportional hargard model analysis revealed that N stage,gross toumor volume were the factors influencing the local control,lesion length,N stage were factors influencing the progression-free survival,and T stage,and N stage,gross toumor volume and irradiated fields were independent prognostic factors for the overall survival.(2)The comparative study effect of difference remedial model(radical radiation or chemoradiotherapy): the 1,3,5 year local control rate of radiation therapy and chemoradiotherapy were 73.5%,48.1%,39.5% and 66.1%,42.2%,38.5%(χ2=1.019,P=0.313),respectively;the1,3,5 year progression-free survival rate were 62.9%,32.0%,18.1% and 54.7%,26.9%,17.3%(χ2=2.136,P=0.144),and the 1,3,5 year survival rate were 72.5%,30.3%,17.4% and 73.3%,37.2%,19.5%(χ2=0.978,P=0.323)respectively.The univariate analysis showed that clinical TNM stage and dose of radiotherapy were the great factors of local control;lesion length and largest diameter of lesion,T stage,N stage,clinical TNM stage were the factors that influence progression-free survival.N stage,and clinical TNM stage were the factors affecting long-time survival.(3)The survival rate and its factors influence of patients with the chemoradiotherapy,Univariate analysis revealed that N stage,clinical TNM stage,and cycles of chemotherapy and dose of radiotherapy have influences on the local control.T,N stage and Clinical TNM stage,cycles of chemotherapy,irradiated fields were relevant to the long-term survival.Multivariate analysis revealed N stage,clinical TNM stage,and cycles of chemotherapy were independent factors for the overall survival rates and clinical TNM stage were the independent factors of local control for esophageal carcinoma patients in intermediate and advanced stages.(4)Toxicity: the ≥2 grade myelosuppression of patients with chemoradiotherapy group(232 cases)were higher to those of the single radiotherapy,there were statistically significant(χ2=79.999,P=0.000).the ≥2 grade myelosuppression of patients with concomitant chemotherapy were higher than those of the sequenced chemotherapy,there were statistically significant(χ2=11.139,P=0.001);the ≥2 grade myelosuppression of ≥4 cycles with chemotherapy patients were higher than those of < 4 cycles,there were no statistically(χ2=3.813,P=0.051).Conclusion:1 N stage and gross toumor volume were the independent factors of local control,progression-free survival and overall survival;irradiation range was the prognostic factors of overall survival.Which showed that patients with the earlier stage patents,and smaller tumour volume received the elective nodal irradiation had better prognosis;2 For the patients with early stage of esophageal carcinoma,the therapy effects of chemoradiotherapy were superior to those of radiation therapy;and the effect of long-term survivcal was no statistically significant between radiotherapy groups and chemoradiotherapy groups.3 The concurrent chemoradiotherapy combined with consolidation chemotherapy,which should increase the local control and improve long-time survival. |
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