| Objective: This study aims to analyze the outcomes and prognostic factors in patients with esophageal squamous cell carcinoma(ESCC)after radiotherapy or chemoradiotherapy,and evaluate the efficacy and toxicity of different treatment modalities of non-surgical esophageal cancer,and to observe the outcomes and acute toxic reaction for esophageal carcinoma with different irradiation dose groups,we also evaluated the efficacy of consolidation chemotherapy(CCT)after concurrent chemoradiotherapy,in order to provide reference for treatment options for non-surgical esophageal patients.Methods: A Iotal of 262 patients with esophageal squamous cell carcinoma who received radiotherapy were enrolled in the clinieal study from 2004 to 2013.The overall survival(OS)and progression-free survival(PFS)were observed and compared in each group of patients,and treatment-related acute toxicity reactions were compared.In addition,we also evaluate the related prognostic factors.Results: Among 262 EC patients,124 cases received concurrent chemotherapy(CCRT),41 received sequential chemoradiotherapy(SCRT),and97 received radiotherapy(RT)alone.Among the patients who received CCRT(n=124),17 received CCRT <60Gy,51 received 60-65 Gy CCRT,and 56 received > 65 Gy CCRT.In addition,patients who underwent CCRT were divided into two groups: those who received consolidation chemotherapy(n=65)and those who did not receive consolidation chemotherapy(n=59).Our results indicated that the objective remission rate(CR+PR)for CRT group and RT alone group was 90.3% and 73.2%(P=0.007),respectively.For the entire group of patients,the 1-,3-and 5-year OS were 69.6%,32.1% and 22.5%,respectively.For CRT group,1-,3-and 5-year OS rates were 75.3%,35.6% and25.5%,while 61.5%,26.7% and 17.6% for RT alone group(P=0.015),respectively.For CCRT group,1-,3-and 5-year OS rates were 78.2%,36.1%and 26.1%,while 65.6%,34.4%,and 23.7% for SCRT group(P=0.568),respectively.The 1-,3-and 5-year PFS rates were 63.9%,24.9%,and 17.4%,respectively,for the CCRT group and 52.8%,19.9%,and 11.2%,respectively,for the SCRT group(P=0.012).The high dose CCRT(60-65Gy)was significantly associated with higher OS(P=0.026)and PFS(P=0.037)when compared with low dose CCRT(<60Gy).Compared with excessive dose CCRT(>65Gy),high dose CCRT tended to prolong the OS P=0.033),but no significant difference in PFS rates was observed between these two groups.For CCRT with CCT group(CCRT+CCT),1-,3-and 5-year OS was 83.7%,41.9% and 30.5%,while 71.2%,30.4% and 21% for CCRT without CCT group(CCRT alone),respectively(P=0.236).However,the CCRT+CCT group got better PFS(70.5%,31.2% and21.8 versus 57.6%,17.7% and 12.1%,P=0.020).In addition,the median OS and PFS for CCRT alone group were 19 months and 12 months,respectively,while for the CCRT+CCT group,the median OS and PFS were 25 months and 18 months.Patients who received CRT developed significantly more leukopeniaabove grade 2 compared with RT alone(P<0.05),at an irradiation dose of >65Gy,there was a clear difference in the incidence of radiation esophagitis between the two groups.And there was no significant difference between CRT and RT alone geoups with respect to radiation esophagitis,radiation pneumonitis and thrombocytopenia.In the multivariate Cox regression analysis,our results demonstrated that only weight loss and T stage were identified as having prognostic significance for OS(P<0.05),and treatment group(RT alone),T stage(T3-4),N stage(N1)and clinical stage(stage 3-4)were associated with a poor prognosis for PFS.Conclusion: The efficacy of chemoradiotherapy for non-surgical ESCC was significantly better than that of radiotherapy alone.The treatment modality of radiotherapy combined with concurrent chemotherapy was worthy of recognition.The concurrent chemoradiotherapy with a dose of 60-65 Gy showed a higher survival benefit and good treatment tolerance;The consolidation chemotherapy after CCRT can improve the PFS,and does not significantly increase acute toxicities,the efficacy of consolidation chemotherapy is worthy of recognition. |
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