| Background and purpose:The incidence and mortality of esophageal cancer have been among the highest in the world for malignant tumors,and the proportion of elderly patients is large.At present,the comprehensive treatment based on surgery is the main treatment mode of locally advanced esophageal cancer.However,the physiological reserve function of elderly patients is decreased,often combined with a variety of chronic diseases,so it is often excluded from clinical trials.The treatment options lack data support and controversy.Therefore,while ensuring clinical efficacy and not increasing the toxicity of radiotherapy and chemotherapy,whether to choose a low-toxic,well-tolerated chemotherapy drug combined with small irradiation field for elderly esophageal cancer needs further exploration.This article retrospectively analyzed 164 patients with esophageal cancer aged ?70 years who were admitted to the Department of Radiotherapy,the First Affiliated Hospital of Bengbu Medical College from 2015 to 2017.To observe the clinical efficacy and adverse reactions of involved-field intensity modulated intensity radiotherapy combined with S-1concurrent chemotherapy in elderly esophageal cancer patients,and to analyze the related prognostic factors.Methods:To collect the clinical data of 164 elderly patients with esophageal cancer over 70 years old who received involved-field intensity modulated intensity radiotherapy or combined chemotherapy from January 2015 to December 2017.To observe the clinical efficacy and toxicity,and to analyze the related factors such as concurrent chemotherapy and tumor staging.Results: The median follow-up time of survivors was 25.1 months(range 11.9-46.4months),and the OS of 1 year and 3 years in CRT group and RT group were 61.7%,41.8% and 54.8%,18%,respectively(P=0.029).The PFS of 1 year and 3 years were65.6%,54.5 and 60.1%,30.8% respectively(P=0.071),and the LRFFS of 1 year and 3years were 55.0%,41.2% and 48.5%,20.4% respectively(P=0.082).Univariate analysis showed that clinical stage I-II,T1-3,no lymph node metastasis,concurrent chemotherapy had better OS,and T1-3,clinical stage I-II and had better OS and PFS,tumor length ? 6.5 cm suggests a worse LRFFS.Further multivariate analysis showed that concurrent chemotherapy was an independent prognostic factor for OS.Clinical stage has significant predictive value for both OS and PFS,and T stage can predict LRFFS.Among the patients in the CRT group,23 were CR,23 were PR,10 were SD,and 4 were PD.Among the patients in the RT group,21 were CR,55 were PR,23 were SD,and 5 were PD.There was no significant difference between the CRT group(76.7%)and the RT group(73.1%),P=0.612.In terms of failure mode,CRT group failed 32 cases,including local-area failure in 24 cases(75.0%),distant metastasis in 8 cases(25%),RT group failure in 70 cases,and local-region failure in56 cases(80.0)%),14 cases(20.0%)were transferred in the distance.There were no significant differences in local-regional failure and distant metastasis between the two groups(P =0.088 and P=0.981,respectively).The acute toxicity associated with treatment in the CRT group and the RT group was mainly grade 1 or grade 2,and the incidence of grade 3 was extremely low(all < 3.5%).The incidence of upper gastrointestinal reaction was higher in the CRT group than in the RT group(P=0.006),there is no significant difference in residual toxicity.One patient in the RT group developed a grade 4 hematologic toxicity response and successfully completed the treatment after treatment.There were no treatment-related deaths in either group.Conclusion: Under the modern intensity-modulated radiotherapy technology,IFI combined with S-1 concurrent chemotherapy can improve the 3-year survival rate of elderly patients with esophageal cancer,and the toxicity associated with treatment can be tolerated without significant increase.It is an more ideal treatment for elderly patients with esophageal cancer. |
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