Efficacy And Safety Analysis Of Radiotherapy On Esophageal Cancer With Metastatic Lymph Nodes

Part I:Efficacy analysis of radiotherapy with or without chemotherapy on lymph node recurrence after radical resection of esophageal squamous cell carcinomaIntroduction:Patients with regional lymph node recurrence after radical resection of esophageal cancer have poor therapeutic outcomes.Currently,there is no standard treatment for regional lymph node recurrence,and its prognostic risk factors are not well-understood.The aim was to evaluate the clinical efficacy and prognostic factors of salvage radiotherapy with or without chemotherapy in these patients.Methods:The survival and prognostic factors of 83 patients with esophageal squamous cell carcinoma with regional lymph node recurrence after radical surgery were retrospectively analyzed.All patients underwent radiotherapy,of which 74 patients received volumetric modulated arc therapy,9 patients received three-dimensional conformal radiation therapy,administered using a conventional segmentation protocol with a dose distribution range of 50.4-66.2Gy(median dose of 60Gy).The concurrent chemotherapy regimen was mainly composed of either platinum or fluorouracil monotherapy,except for 4 patients who were given platinum plus 5-fluorouracil or paclitaxel.Results:The median follow-up time was 24(range,9-75)months.The overall survival(OS)rates at 1 year,3 years,and 5 years were 83.0,40.1,and 35.1%,respectively.The 3-year survival rate was 47.5%in patients with radiation alone and 41.9%in patients receiving concurrent chemoradiotherapy.There was no significant difference in overall survival rate between the two groups(p=0.570),while the response rate(CR+PR)in those two groups was 73.2 and 91.4%,respectively.By multivariate analysis of OS,age(worse in younger patients,p=0.034)was found to be significantly associated with disease prognosis.The commonly toxicities were esophagitis,leukopenia and anemia.18%patients experienced grade 3 toxicity and no treatment-related death occurred.Conclusions:These results of this retrospective analysis suggest that radiotherapy with or without chemotherapy is an effective and feasible salvage treatment for lymph node recurrence after radical resection of esophageal squamous cell carcinoma.Part II:Definitive Radiotherapy with or without Chemotherapy Versus Surgery with Incomplete Lymph Node Dissection Followed by Postoperative Adjuvant Therapy for Resected Node-Positive Esophageal Squamous Cell CarcinomaIntroduction:Radical resection of esophageal cancer results in poor therapeutic outcomes when residual lymph nodes occurred.This retrospective study aimed to determine whether definitive radiotherapy with or without chemotherapy(CRT/RT)improve overall survival(OS)compared with surgery(radical esophagectomy with incomplete lymph node dissection)followed by adjuvant therapy among such patients with node-positive esophageal squamous cell carcinoma.Methods:We selected a total of 219 patients with node-positive esophageal cancer,between January 2012 and December 2018.Of these,122 patients received definitive CRT/RT,while 97 were subjected to radical esophagectomy,with incomplete lymph node dissection followed by adjuvant radiotherapy(defined as incomplete lymph node dissection with postoperative radiotherapy group).Overall survival rates were compared among patients treated with definitive CRT/RT and those who underwent incomplete lymph node dissection,and propensity-matched analysis further performed to reduce confounding factors associated with the 2 procedures.Results:For patients treated with definitive CRT/RT,all completed radiotherapy with the median dose of 60Gy(range,50.4 to 66.0Gy).The concurrent chemotherapy regimen was mainly composed of fluorouracil,platinum or paclitaxel.For patients treated with incomplete lymph node dissection,all received postoperative radiotherapy.After propensity score matching,we recorded a 5-year overall survival rate of 47.6 and 18.9%(p=0.039)in the definitive CRT/RT and incomplete lymph node dissection with postoperative radiotherapy groups,respectively.Cox regression analysis,for prognosis,revealed that higher clinical stage and surgery with incomplete lymph node dissection yielded a high relative risk value.Conclusions:The findings herein indicate that definitive CRT/RT provides better survival rates than surgery with incomplete lymph node dissection for patients with node-positive ESCC,when residual lymph nodes are subjected to salvage treatments.