| Background and Objectives: Radical chemoradiotherapy is an important treatment for esophageal cancer,but most patients will have local recurrence after radical chemoradiotherapy.The treatment of local recurrence after radiotherapy is currently a clinical difficulty.Although there are guidelines for salvage surgery,most patients lose their chance of surgery in clinical practice.Intensity-modulated radiotherapy(IMRT)is a widely used radiotherapy method.It not only can well adapt to the shape of tumor lesions,but also can adjust the dose,increase the amount of radiation on the tumor,and reduce the irradiation on the surrounding tissue.The technical advantages of IMRT make it possible to perform re-radiation after local recurrence,providing a new treatment for patients who cannot be operated.At present,there are few studies on re-intensity-modulated radiotherapy(re-IMRT)at home and abroad.This study,through retrospective study,analyzes the efficacy and safety of re-IMRT for patients with local recurrence after radiotherapy.Methods: We retrospectively reviewed the data of all esophageal cancer patients from January 2009 to June 2015 in our hospital,and screened out patients with esophageal cancer who were eligible for enrollment,and conducted follow-up and follow-up.The final follow-up time was 2018.6 30.To observe the general data,short-term efficacy,long-term survival,hematology,and radiation injury in patients with recurrent intensity-modulated radiotherapy,evaluate the efficacy and safety,and analyze the prognostic factors.The patients who underwent re-IMRT were divided into the re-radiation chemotherapy group and the re-radiation radiotherapy group to analyze thevalue of concurrent chemotherapy.Results: Of the 41 patients with esophageal cancer who met the enrollment criteria from January 2009 to June 2015,37 patients completed re-IMRT,and 4 patients gave up treatment halfway.At the end of the follow-up period,1 patient was lost to follow-up and 2 patients survived.Of the 37 patients who underwent re-IMRT,CR was 3(8.1%),PR was 20(54.1%),NR was 14(37.8%),and RR was 23(62.2%).The OS of 37 patients was 2 to 56 months,with a median survival time of 9 months and an average survival time of 15 months.The 1-year,2-year,and 3-year survival rates were 45.9%,21.6%,and 10.8%,respectively.In 37 patients with recurrent radiotherapy,the incidence of esophageal fistula was 10.8%(4/37),1 patient had grade 3 radioactive pericarditis,and 1 patient died of major bleeding.The other adverse reactions were mild.There was no significant difference in short-term efficacy(P=0.303),long-term survival(P=0.245),and adverse events in the re-radiotherapy group and the re-radiation group.Analysis of factors affecting prognosis showed that age,recurrence interval,KPS,and re-IMRT efficacy were single factors affecting prognosis,in COX multivariate analysis,only age(P=0.008,RR=3.329,95% CI: 1.363~8.132)and recurrence interval(P=0.031,RR=0.470,95% CI:0.237~0.934)were independent prognostic factors.Conclusion: Re-IMRT is a good and safe treatment for patients with local recurrence after radiotherapy for esophageal cancer.Whether to synchronize chemotherapy still needs to be studied. |
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