| Objective: By using the criteria based on barium radiography and computed tomography(CT)examination to evaluate the recent curative effect and prognosis of esophageal carcinoma after radiotherapy,this research aims at verifying the feasibility of this standard and the value of predicting prognosis,putting forward some suggestions for improvement,and providing basis for clinical application.Method: Patients with esophageal carcinoma who received 3DCRT or IMRT treatment with or without chemotherapy were enrolled from January2004 to December 2015.The prescription dose was as the following Plan:median 60Gy(50-69Gy),single dose 1.7-2.2Gy,1 time / day,5 times a week.Among these patients,140 patients underwent concurrent,neo-adjuvant or adjuvant chemotherapy.According to the 2013 new standard criteria for evaluating the radiotherapy effect,all patients' esophageal barium examination,chest and upper abdominal CT images were collected at the beginning and the end of radiotherapy to observe the survival and local control.Results:1 The overall 1,3 and 5-year local control rates of the patients after radiotherapy were 80.2%?62.0% and 55.1% and the overall 1,3 and 5-year survival rates were 68.2%?36.3% and 26.3%.2 In 529 patients,except for the 11 cases of NR evaluated by barium radiography,the 1,3 and 5-year local control rates and survival rates of the patients evaluated by barium radiography as CR were 85.4% ? 71.1% and64.7% as well as 75.8%?47.4% and 35.3%,respectively.The 1,3 and 5-year local control rates and survival rates of the patients evaluated by barium radiography as PR were 77.5%?54.2% and 46.0% as well as 64.5%?27.9%and 19.0%.There was a significant difference between the CR group and the PR group in the local control and survival rate(?2=10.743 P=0.001;?2=16.412P=0.000).The survival time of NR group was 2-18 months(median survival was 5 months).3 The maximal esophageal wall thickness was ranged from 0.36 cm to3.45 cm(median value 1.07cm)estimated by CT examination after radiotherapy.The survival analysis was performed by using CT to measure the maximum wall thickness(cutting-off value 1.20cm).Results showed that there was a significant difference in the local control rates and survival rates between the group of patients with the maximum esophageal wall thickness? 1.20 cm and the group with the maximum esophageal wall thickness >1.20cm(?2=7.320 P=0.007;?2=15.317 P=0.000).The 1,3 and 5-year local control rates of the two groups were 84.8%?64.5% and 55.8% as well as70.4%?55.7% and 51.6%,respectively.The 1,3 and 5-year survival rates of the two groups were 74.6%?41.9% and 29.1% as well as 55.0%?25.1% and19.3%,respectively.4 Based on the maximal esophageal wall thickness(cutting-off value1.20cm),patients evaluated by barium radiography as CR and PR were respectively divided into two groups.Results showed no differences in the local control rates and survival rates between the group of patients evaluated by barium radiography as CR with the maximum esophageal wall thickness? 1.20 cm and patients evaluated by barium radiography as CR with the maximum esophageal wall thickness >1.20cm(?2=0.652 P=0.419;?2=1.980P=0.159).The local control rates and survival rates of patients evaluated by barium radiography as PR with the maximum esophageal wall thickness ?1.20 cm estimated by CT examination were higher than those evaluated as PR with the maximal esophageal wall thickness >1.20cm(?2=4.819 P=0.028;?2=9.538 P=0.002).The 1,3 and 5-year local control rates of the two groups were 82.7%?53.5% and 45.6% as well as 68.4%?50.2% and 43.3%.The 1,3and 5-year survival rates of the two groups were 72.3%?33.2% and 19.0% as well as 50.9%?18.7% and 14.8%.5 There were 149 cases of esophageal carcinoma patients without lymph node metastasis and 380 cases with lymph node metastasis.There were 35 patients whose lymph nodes disappeared after treatment and 1 patient presented with new lymph node metastasis.The barium radiography evaluation of the patient with presence of new lymph node metastasis was PR,and the survival time was 39 months.The volume of residual metastasis lymph node was in the range of 0.08-52.23cm3(median value 1.24cm3)estimated by CT examination after radiotherapy.Based on the volume of residual metastatic lymph node estimated by CT examination(cutting-off value 1.00cm3),the survival rates of patients with the volume of residual metastatic lymph node ?1.00cm3 were significantly higher than those with the volume of residual metastatic lymph node > 1.00cm3(?2=11.792P=0.001).The 1,3 and 5-year survival rates of the two groups were 74.6%?48.1% and 31.2% as well as 61.8% ? 26.4% and 18.3%.There was no significant difference between the group of patients without lymph node metastatic after radiotherapy and the group with the volume of residual metastatic lymph node ?1.00cm3(?2=0.698 P=0.403).Patients evaluated by barium radiography as CR and PR with residual metastatic lymph node were respectively divided into two groups based on the residual metastatic lymph node volume(cutting-off value 1.00cm3).The survival rates between the group of patients evaluated by barium radiography as CR with the volume of residual metastatic lymph node ? 1.00cm3 was higher than patients evaluated by barium radiography as CR with the volume of residual metastatic lymph node >1.00cm3(?2=6.862 P=0.009).The 1,3 and 5-year survival rates of the two groups were 82.1%?56.7% and 35.4% and 68.4%?29.7% and20.8%.There was also significant difference in survival rates between patients evaluated by barium radiography as PR with the volume of residual metastatic lymph node ?1.00cm3 estimated by CT examination and patients evaluated by barium radiography as PR with the volume of residual metastatic lymph node >1.00cm3(?2=4.968 P=0.026).The 1,3 and 5-year survival rates of the two groups were 72.5% ? 43.6% and 30.5%,59.2% ? 25.8% and 17.9%,respectively.The short diameter of residual metastasis lymph node was in the range of 0.37-3.40cm(median value 0.85cm)estimated by CT examination after radiotherapy.Based on the short diameter of residual metastatic lymph node(cutting-off value 1.00cm3)estimated by CT examination,the survival rates of patients with the short diameter of residual metastatic lymph node ?1.00 cm were significantly higher than those with the short diameter of residual metastatic lymph node >1.00cm(?2=17.206 P=0.000).The 1,3 and 5-year survival rates of the two groups were 72.5%?41.1% and 29.7% as well as55.8%?22.5% and 10.4%,respectively.There was no significant difference between the group of patients without lymph node metastatic after radiotherapy and the group with the short diameter of residual metastatic lymph node ?1.00cm(?2=2.002 P=0.367).6 Survival analysis was performed on 529 patients with the recent evaluation standard of CT combined with barium radiography.The 1,3 and5-year local control and survival rates of the 109 patients evaluated by barium radiography as CR with the maximal esophageal wall thickness ?1.20 cm and the volume of residual metastatic lymph node ? 1.00cm3 estimated by CT examination were 91.3%?78.2% and 68.7% as well as 83.5%?60.7% and44.7%.The 1,3 and 5-year local control and survival rates of the 408 patients evaluated by barium radiography as PR or with the maximal esophageal wall thickness >1.20 cm and those evaluated as CR with the maximal esophageal wall thickness ?1.20 cm but the volume of residual metastatic lymph node>1.00cm3 estimated by CT examination were 77.9%?57.3% and 52.1% as well as 65.4%?30.1% and 21.8%,respectively.The log-rank test showed a significant local control and survival difference between the two groups(?2=10.685 P=0.001;?2=21.577 P= 0.000).The survival time of NR group(12 cases)was 2-39 months(median survival was 6 months).7 The 1,3 and 5-year local control and survival rates of the 132 patients evaluated by barium radiography as CR with the maximal esophageal wall thickness?1.20 cm and the short diameter of residual metastatic lymph node?1.00 cm estimated by CT examination were 88.8%?73.8% and 66.6% aswell as 84.1% ? 57.3% and 43.2%.The 1,3 and 5-year local control and survival rates of the 385 patients evaluated by barium radiography as PR or with the maximal esophageal wall thickness>1.20 cm and those evaluated as CR with the maximal esophageal wall thickness ? 1.20 cm but the short diameter of residual metastatic lymph node > 1.00 cm estimated by CT examination were 78.0%?57.7% and 51.4% as well as 64.2%?29.3% and20.8%,respectively.The log-rank test showed a significant local control and survival difference between the two groups(?2=7.691 P=0.006;?2=23.279P=0.000).Conclusion: There is a limitation of simple application of esophageal barium radiography on the evaluation of radiotherapy effect of esophageal cancer.The maximum wall thickness and residual lymph node volume were prognostic factors for patients with esophageal carcinoma after radiotherapy.The recent curative effect evaluation standard of CT combined with barium radiography in evaluating the efficacy of radiotherapy in patients with esophageal cancer and assessing prognosis is feasible.The short diameter is also a prognostic factor for patients with esophageal carcinoma after radiotherapy and patients with the short diameter of residual metastatic lymph node?1.00 cm has good prognosis.The volume of residual metastatic lymph node can be replaced by the short diameter in the application of the new evaluation criteria. |
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