Clinical Analysis Of Involved-field Irradiation And Elective Nodal Irradiation In Advanced Esophageal Cancer

ObjectiveThis study evaluated the efficacy and toxicity of patients with locally advanced esophageal cancer receiving different radiation field radiotherapy,and then explored the feasibility and advantages of locally advanced esophageal cancer with IFI to screen out patients with esophageal cancer involving invasive radiotherapy.MethodsThe retrospective study was preformed on the clinical records of 160 patients with locally advanced esophageal cancer,who have received definitive radiotherapy and chemotherapy between January 1,2012 and December 31,2014,in the First Affiliated Radiology Department of Bengbu Medical College,including 80 patients with ENI,and 80 patients with IFI.To analyze the different failure modes,survival rates and toxicities between two groups of patients with locally advanced esophageal cancer.Results1.In the ENI group,CR+PR was achieved in 72 patients(90.5%)and in the IFI group in 70 patients(88.0%).There was no significant difference between the two groups(P=0.617),3-year survival rate,and ENI group was 30.0%.IFI group was 36.3%,there was no significant difference between the two groups(P=0.108).2.The median follow-up time is 26 months.Local treatment failures,regional lymph node treatment failure and distant metastases were 37(46.3%),7(8.8%),9 (11.3%)in the ENI group patients,and were 41(51.3%),16(20.0%),12(15.0%)in the IFI group patients.And there was a significant difference in the lymph nodes treatment failure between the two groups(P=0.043).3.The incidence of radiation pneumonitis and radiation esophagitis in the ENI group was greater than that in the IFI group(P=0.043,P=0.036),and the lung V10(%),V20(%)and average lung volume of ENI group were greater than the IFI group,the difference was significant(P=0.044,P=0.015 and P=0.01).Conclusion1.Compared with elective nodal irradiation,although involved field irradiation increased the treatment failure rate of regional lymph nodes,it has no significant difference on the survival rate of locally advanced esophageal cancer patients.2.Local treatment failure is the main failure mode of definititive radiotherapy in patients with locally advanced esophageal cancer.3.Compared with ENI,IFI can reduce radiation-related toxicity.