| Objective: To analyze the clinical features,short-term efficacy,prognostic factors and therapeutic side effects of patients with local recurrence esophageal squamous cell carcinoma after radical chemoradiotherapy who underwent salvage radiochemotherapy,and to investigate the effects of Re-irradiation therapy and concurrent chemoradiotherapy under precise irradiation techniques.Methods: A retrospective analysis of 109 patients with local recurr ence after definitive chemoradiotherapy for esophageal squamous cell car cinoma treated in the Fourth Hospital of Hebei Medical University from January 2008 to December 2016.Among them,there were 71 males(65.1%)and 38 females(34.9%);The median age was 66 years(43-89 y ears);There were 75 patients(68.8%)with local recurrence only,and 34patients(31.2%)with local recurrence and regional lymph node recurre nce;79 patients with Re-irradiation therapy(re-RT),and 30 patients wit h Re-concurrent chemoradiotherapy(re-CCRT).To explore the effects on short-term efficacy and survival of different clinical features and treatm ent modes,and to evaluate the side effects of Re-chemoradiotherapy.Results:1.Short-term efficacy: The objective response rate(ORR)of the w hole group was 64.2%.Univariate analysis showed that the recurrence i nterval,length of lesion,and Re-irradiation therapy dose were the main factors affecting ORR.The ORR of patients with recurrence interval >24 months was significantly higher than that of patients with ?24 month s(77.8% vs 57.5%,2=4.300,p=0.038).The ORR of lesion length?3cm,>3,?5cm and >5cm were 89.5%,63.8%,and 53.5%,respectively,the difference was statistically significant(?2=7.432,p=0.024).The results of the pairwise comparison showed that lesion length ?3cm Significantl y higher than the lesion length >3,?5cm and >5 cm group(?2=4.340,p=0.037;?2=7.454,p=0.006).The ORR of re-irradiation therapy dose ?50Gy,>50,?54Gy,and >54Gy were 51.9%,71.4%,and 79.3%,resp ectively,and the difference was statistically significant(?2=6.929,p=0.031).The results of the pairwise comparison showed that the ORR of the re-irradiation therapy dose >54Gy group was significantly higher than t hat of the ?50Gy group(79.3% vs 51.9%;?2=5.445,p=0.020).There was no significant difference in the ORR ?2 test between Re-irradiation therapy and Re-concurrent chemoradiotherapy(62.0% vs 70.0%,?2=0.602,p=0.438).The improvement rate of Dysphagia(DIR)was 63.0%(58/92).Uni variate analysis showed that tumor control after re-treatment was the ma in factor affecting DIR.The DIR of the CR+PR patients was significant ly higher than that of the NR patients(83.6% vs 22.6%,?2=32.855,p<0.001).There was no significant difference in the DIR ?2 test between be tween Re-irradiation therapy and Re-concurrent chemoradiotherapy(65.7% vs 56.0%,?2=0.731,p=0.393).2.Survival: The media-After recurrence survival(mARS)was 8.0 months,1-,2-,3-,and 5-year survival rates were 32.1%,16.5%,8.3%,and 3.7%,respectively. Univariate analysis showed that the recurrence interval,the lesion le ngth,and the Re-irradiation therapy dose were the influencing factors of after recurrence survival(ARS).The 1-,2-,and 3-year survival rates o f recurrence interval >24 months were 41.7%,22.2%,and 11.1%,which were significantly higher than the recurrence interval ?24 months of 26.0%,13.7%,and 7.8%(?2=6.172,p=0.013);The 1-,2-,and 3-year sur vival rate of lesion length ?3cm was 42.1%,26.3%,15.8%,The 1-,2-,and 3-year survival rate of lesion length >3,?5cm was 38.3%?19.1%?12.2%.The 1-,2-,and 3-year survival rates of lesion length >5cm was 18.6%,9.3%,and 3.5%,and the median survival was 9.0 months,9.0 months,and 5.0 months,respectively(?2=8.656,p=0.013).Poor pro gnosis in patients with long esophageal recurrent lesion length.The 1-,2-,and 3-year survival rate of re-irradiation therapy dose ?50Gy was 26.9.%,11.5%,4.8%,The 1-,2-,and 3-year survival rate of re-irradiati on therapy dose >50,?54Gy was 46.4%,32.1%,17.9%,The 1-,2-,a nd 3-year survival rate of re-irradiation therapy dose >54Gy was 27.6%,10.3%,and 6.9%.The median survival time was 6.0 months,10.0 mo nths,and 8.0 months(?2=6.385,p=0.041).The survival condition was r elatively good in the group with re-irradiation therapy dose >50,?54G y.The 1-,2-,and 3-year survival rates of CR patients were 83.3%,66.7%,and 50.0%.The 1-,2-,and 3-year survival rates of PR patients we re 34.4%,17.2%,and 6.3%.The 1-,2-,and 3-year survival rates of N R patients were 17.9%,7.7%,and 5.1%.The median survival time was31.0 months,8.0 months,and 6.0 months(?2=13.328,p=0.001).The s urvival rate of CR patients was significantly higher than those with PR and NR(?2=5.763,p=0.016;?2=11.154,p=0.001).The survival rate of PR patients was significantly higher than those with NR(?2=4.879,p=0.027).The 1-,2-,and 3-year survival rates of the re-irradiation therapy group were 30.4%,13.9%,and 5.7%.The 1-,2-,and 3-year survival ra tes of the concurrent chemoradiotherapy group were 33.3%,23.3%,and 16.6%.The median survival time was 8.0 months and 7.0 months,respe ctively,and the difference between the two groups was not statistically significant(?2=2.085,p=0.149).Multivariate analysis showed that the recurrence interval were indep endent factors of after recurrence survival(ARS).3.Toxic and side effects: The incidence of myelosuppression in gra de 2 and above was 2.7% and 36.7% in the Re-irradiation therapy grou p and the Re-radiochemotherapy group,respectively.The incidence of myelosuppression was higher in the Re-concurrent chemoradiotherapy than in the Re-irradiation therapy group(?2= 18.151,p < 0.001).The incidence of radiation pneumonitis in grade 2 and above was 31.6% and 36.7% in the Re-irradiation therapy group and the Re-radioc hemotherapy group,respectively.The incidence of radiation pneumonitis in the Re-concurrent chemoradiotherapy group was slightly higher than t hat in the Re-irradiation therapy group,but the difference was not statis tically significant(?2=0.248,p=0.619).The incidence of radiation esophagitis in grade 2-3 in the Re-irradi ation therapy group and the Re-concurrent chemoradiotherapy was 34.2%and 36.7%,respectively,and the difference was not statistically signific ant(?2=0.509,p=0.808).There were 23 cases(21.1%)of esophageal fistula in the whole gr oup,including 9 cases of esophageal mediastinum fistula,14 cases of e sophageal tracheal fistula,7 cases(30.4%)during radiotherapy,6 cases(26.1%)within 3 months after radiotherapy,and 10 cases after 3 month s of radiotherapy(43.5%).Univariate analysis showed that the dose of r ecurrent radiotherapy and tumor control were the main factors affecting the incidence of esophageal fistula.The esophageal fistula incidence of r e-irradiation therapy dose ?50Gy,>50,?54Gy,and >54Gy groups wer e 32.7%,3.6%,17.2%(?2=9.624,p=0.008).The results of the pairwise comparison showed that the incidence of esophageal fistula in ?50Gy g roup was significantly higher than >50,?54Gy group(?2=8.851,p=0.003).There was no significant difference between the >54Gy group and>50,?54Gy group or ?50Gy group(?2=1.561,p=0.211,?2=2.247,p=0.134).The incidence of esophageal fistula in patients with CR+PR an d NR was 12.9% and 35.9%,respectively(?2=7.986,p=0.005),and the incidence of esophageal fistula in CR+PR patients was significantly low er than that in NR patients(?2=7.986,p=0.005).There were 17(21.5%)patients in the re-irradiation therapy group and 6 patients(20.0%)in the re-concurrent chemoradiotherapy group,the difference was not statistic ally significant(?2=0.030,p=0.862).4.Analysis of the cause of death: 109 patients in the whole group,100 patients died at the time of follow-up,8 patients survived,and 1 patient was lost to follow-up.Local recurrence/progression in 10 cases,esophageal fistula in 15 cases,upper gastrointestinal bleeding in 13 case s,distant metastasis in 10 cases,pulmonary infection in 6 cases,dyscras ia in 16 cases,hemoptysis in 1 case,heart disease in 1 case,and with unknown reasons in 28 cases.Among them,1 case died of hematemesis during radiotherapy,and 1 case died of esophageal tracheal fistula com bined with hematemesis.Conclusion:1.Re-irradiation therapy for patients with local recurrence of esoph ageal squamous cell carcinoma after definitive chemoradiotherapy can ac hieve better objective response rate and improve dysphagia,but survival after recurrence is still poor,and concurrent with chemotherapy shows no advantage.2.Re-irradiation dose selection is recommended above 50 Gy,and >50,?54Gy may be a better choice.3.The recurrence interval > 24 months has a longer survival time after recurrence. |
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