| Objective:To investigate the effect of definitive radiotherapy on the prognosis of patients with esophageal squamous cell carcinoma in different clinical target areas(CTV),to evaluate the clinical application value of the two target areas to guide individualized treatment.Methods:Retrospective analysis of the clinical data of 118 patients with esophageal squamous cell carcinoma who underwent definitive radiotherapy from January 2016 to December 2018 in Nanchong Central Hospital?The elective nodal prophylactic irradiation(ENI)group(52 cases)and the involving-field irradiation(IFI)group(66 cases)were sorted according to the CTV irradiation range.The overall and stratified comparison of prognosis and adverse reactions between ENI and IFI groups was carried out.Using SPSS 21.0 statistical software for data analysis,using the ?2 test and t test to compare the count data and measurement data,using the Kaplan-Meier method to calculate the survival rate,using the Logrank method for significance testing,P<0.05 was considered as statistical significance.Results:(1)The median overall survival(OS)was 26.3 months,the median progression free survival(PFS)was 21.2 months,and the objective response rate(ORR)was 76.3%.The overall comparison between ENI and IFI groups ORR 80.8%and 72.7%,respectively(P=0.308).The median OS between the overall ENI and IFI groups was 31.7 months and 22.6 months,respectively.The OS rates of 1,2,3 years were 90.3%,62.8%,44.6%and 81.8%,46.2%,17.5%(P=0.007).The median PFS between the overall ENI and IFI groups was 24.7 months and 17.0 months,respectively.The PFS rates of 1,2,3 years were 78.6%,51.0%,30.6%and 69.7%,43.5%,14.5%(P=0.007).Overall comparison ENI patients?grade 2 radiation esophagitis,?grade 2 total adverse reactions,?grade 3 radiation esophagitis,and? grade 3 total adverse reaction ratio were all higher than those in the IFI group,the difference was statistically significant(P<0.05).The local regional failure rate was lower in ENI group than in IFI group(P<0.05).(2)Of the ESCC patients aged ?70 years,the OS rates of 1,2,3 years were 87.1%,67.7%,50.8%and 79.4%,49.3%,15.4%in the ENI and IFI groups,respectively(P=0.024).The PFS rates of 1,2,3 years were 83.9%,54.8%,27.4%and70.6%,46.4%,12.4%in the ENI and IFI groups,respectively(P=0.039).The total adverse reaction rates? grade 2 were 54.8%and 32.4%(P>0.05),respectively.Of the ESCC patients aged>70 years,the OS rates of 1,2,3 years were95.2%,55.1%,35.1%and 84.4%,42.9%,19.8%(P=0.147),respectively.The PFS rates of 1,2,3 years in the ENI and IFI groups were 70.4%,45.2%,3 5.2%and 68.8%,40.4%,16.8%(P=0.094),respectively.The total adverse reaction rate?grade 2 in ENI group was higher than that in IFI group,which was 61.9%and 31.3%,respectively,and the difference was statistically significant(P<0.05).(3)Of the ESCC patients in the ??? period,the OS rates of 1,2,3 years were90.8%,75.0%,53.2%and 85.4%,51.5%,19.3%(P=0.007),respectively.The PFS rates were 84.6%,62.7%,40.8%and 77.1%,47.6%,15.1%(P=0.003),respectively.The total adverse reaction rate?grade 2 in ENI group was higher than that in IFI group,which was 51.5%and 29.2%(P<0.05).Of the ESCC patients in the IVA period,the OS rates of 1,2,3 years in the ENI and IFI groups were 89.5%,42.1%,30.1%and 72.2%,32.4%,13.0%(P=0.247),respectively.The PFS rates of 1,2,3 years in the ENI and IFI groups were 68.4%,30.7%,12.3%and 50.0%,32.4%,13.0%(P=0.402),respectively.The total adverse reaction rates?grade 2 were 68.4%and 38.9%,respectively,with no significant difference(P>0.05).(4)Of the ESCC patients in the stage T1?3,the OS rates of 1,2,3years in the ENI and IFI groups were 91.1%,72.9%,51.6%and 86.3%,54.4%,20.0%(P=0.014),respectively.The PFS rates of 1,2,3years in the ENI and IFI groups were 82.1%,60.8%,39.5%and 78.4%,50.7%,16.2%(P=0.011),respectively.The total adverse reaction rates?grade 2 in ENI and IFI groups were 50.0%and 33.3%(P>0.05),respectively.Of the ESCC patients in the stage T4,the OS rates of 1,2,3 years in ENI and IFI groups were 88.9%,44.4%,31.7%and 66.7%,17.8%,8.9%(P=0.039),respectively.The PFS rates of 1,2,3 years in ENI and IFI groups were 72.2%,32.4%,13.0%and 40.0%,17.8%,8.9%(P=0.086),respectively.The total adverse reaction rate?grade 2 in ENI group was higher than that in IFI group,which was 72.2%and 26.7%(P<0.05).(5)Of the ESCC patients in the stage No,the OS rates of 1,2,3 years were 100.0%,84.6%,61.5%and80.0%,70.0%.0%,70.0%,30.0%(P=0.048),respectiv ely.The PFS rates of 1,2,3 years in ENI and IFI groups were 92.3%,76.9%,53.8%and 80.0%,70.0%,20.0%(P=0.027),respectively.Of the ESCC patients in the stage N1,the OS rates of 1,2,3 years in ENI and IFI groups were 94.1%,58.8%,32.7%and 76.5%,38.2%,5.9%(P=0.046),respectively.The PFS rates of 1,2,3 years in ENI and IFI groups were 83.0%,41.5%,20.7%and 61.8%,32.4%,5.9%(P=0.043),respectively.Of the ESCC patients in the stage N2?3,the OS rates of 1,2,3 years in ENI and IFI groups were 81.0%,47.6%,37.5%and 90.9%,48.3%,32.2%(P=0.887),respectively.The PFS rates of 1,2,3 years in ENI and IFI groups were 66.7%,42.9%,23.8%and 77.3%,50.0%,27.8%(P=0.7 75),respectively.Of the ESCC patients in the N0 and N1 stages,the total adverse reaction rate?grade 2 was higher in the ENI group than in the group,61.5%,66.7%and 10.0%,23.5%(P<0.05).Total adverse reaction rates of?grade 2 in ENI and IFI groups were 47.6%and 54.5%(P>0.05)in patients with stage N2?3.(6)Of ESCC patients with esophageal lesion length>5 cm and ?5 layers,the OS rate and PFS rate of 1,2,3 years were not statistically significant compared between ENI and IFI groups(P<0.05).Of ESCC patients with lesion length>5 cm,the total adverse reaction rates of?grade 2 adverse reactions was higher in ENI group than in IFI group,59.4%and 34.1%(P<0.05).Of ESCC patients with lesion length ?5 cm,the incidence of?grade 2 adverse reactions in ENI and IFI groups was 55.0%and 28.0%,respectively,with no significant difference(P>0.05).GTV volume?32.6cm3 and GTV<32.6cm3 in ESCC patients with each stratification,there was no significant difference between the OS rate and the PFS rate in ENI and IFI groups(P>0.05).Of the ESCC patients GTV?32.6cm3,the rate?grade 2 adverse reactions in the ENI group was higher than that inthe IFI group,63.6%and 33.3%(P<0.05).Of the ESCC patients GTV<32.6cm3,the incidence of?grade 2 adverse reactions in the ENI and IFI groups was 53.3%and 29.6%,respectively,with no significant difference(P>0.05).Grouped by neutrophil-lymphocyte ratio(NLR),the OS and PFS rates of 1,2,,3 years were not statistically significant in the ESCC patients with each stratification of high NLR and low NLR(P>0.05).The rate?grade 2 adverse reactions in ENI group was higher than that in IFI group,which was57.1%and 29.4%(P<0.05).The incidence of?grade 2 adverse reactions in ENI and IFI groups was 58.1%and 34.4%in low NLR patients,difference was not statistically significant(P>0.05).The OS rate and PFS rate of 1,2,3 years and the adverse reaction rate of?grade2 were not statistically significant in the ESCC patients with each stratification in the neck or upper chest segment,middle chest segment and lower chest or abdomen segment(P>0.05).(7)In ESCC patients with radiotherapy alone,the OS rates of 1,2,,3 years in ENI and IFI groups were 88.5%,65.4%,38.5%and 77.5%,49.5%,13.0%(P=0.073),respectively.The PFS rates of 1,2,3 years in ENI and IFI groups were 80.8%,46.2%,30.8%and 67.5%,44.5%,10.5%(P=0.073),respectively.The incidence of?grade 2 adverse reactions in ENI and IFI groups was 42.3%and 25.0%respectively in ESCC patients with radiotherapy alone(P>0.05).In the patients with combined radiotherapy and chemotherapy,the OS rates of 1,2,3 years in the ENI and IFI groups were 92.0%,60.0%,51.4%and 88.5%,41.0%,24.6%(P=0.075),the PFS rates were 76.1%,56.1%,30.2%and 73.1%,42.0%,21.0%(P=0.098)respectively.The incidence?grade 2 adverse reactions in ENI group was higher than that in IFI group,which was 73.1%and 42.3%(P<0.05).Conclusion:(1)The choice of radical radiotherapy is IFI more suitable for ESCC patients with advanced age and late clinical stage.In addition,the choice of patients ENI have the advantage of prolonging survival time,but the side effects of toxicity are also increased,so the clinical individualized choice should be ENI or IFI.(2)ESCC patients with long lesions,large GTV volume,high NLR level,combined with radiotherapy and chemotherapy,radical radiotherapy selection ENI will significantly increase the side effects,so it should be based on age and stage clinical individualized analysis,can choose the IFI as far as possible. |
PDF Full Text Request