| Part I Risk factors for radiation esophagitis and pneumonitis in esophageal cancer patients with diabetes or hypertensionObjective:Radiotherapy is the main method to treat esophageal cancer.Radiation esophagitis and radiation pneumonia are the most common complications of radiotherapy for esophageal cancer(EC).Diabetes and hypertension are common chronic diseases in Chinese residents,and esophageal cancer patients with diabetes or hypertension are also common in clinic.This study investigated the incidence of acute radiation esophagitis and pneumonia in patients with esophageal cancer complicated with diabetes or hypertension after radiotherapy,and analyzed the prognostic factors.Methods:A total of 630 EC patients from 4 cancer centers receiving three dimensional conformal radiation therapy(3D-CRT)or intensity modulated radiation therapy(IMRT)were included in this study.Among these patients,92 showed concurrent with diabetes and 220 with hypertension.The incidence of radiation pneumonia and esophagitis in patients with or without diabetes or hypertension was retrospectively analyzed.Statistical analysis was performed by SPSS 22.0 software package.Survival rate was calculated by kaplan-meier method,univariate prognostic analysis was performed by Logrank,and Cox proportional risk model was used for multivariate analysis.Results:1.The prevalence of grade Ⅰ,Ⅱ,Ⅲ and Ⅳ radiation esophagitis in hypertension and non-hypertension patients was 48.7%、38.2%、9.2%、3.2%and 67.9%、24.6%、5.5%、2.0%,respectively,while that in the grade Ⅰ,Ⅱ and Ⅲ radiation pneumonitis in hypertension and non-hypertension patients were 28.5%、18.4%、5.7%and 28.4%、14.7%、1.5%,respectively.The prevalence of grade Ⅲ or above radiation esophagitis and pneumonitis in patients with hypertension was significantly higher than those with non-hypertension(χ2=6.259,P=0.017 and χ2=10.224,P=0.0020).2.The prevalence of grade Ⅰ,Ⅱ,Ⅲ and Ⅳ radiation esophagitis in diabetes and non-diabetes patients was 40.2%、38.0%、13.5、5.4 and 64.9%、28.1%、4.8%、2.2%,respectively,while that for the grade Ⅰ,Ⅱ and Ⅲ radiation pneumonitis in diabetes and non-diabetes patients was 31.5%、17.3%、8.7%and 27.9%、18.6%、2.0%,respectively.The prevalence of Ⅲ or above radiation esophagitis and pneumonitis in patients with diabetes and was significantly higher than those with non-diabetes(χ2=25.887,P<0.001 andχ2=11.882,P=0.003).3.Diabetes is an independent risk factor for grade Ⅲ or above acute radiation esophagitis and pneumonitis.4.Complete response rate(CR)and partial response rate(PR)were 62.5%and 31.5%,respectively,and total response rate(CR+PR)was 94.0%.The OS rates of 1,3 and 5 years were were 75.6%,40.7%and 27.8%,respectively,and the media survival time(MST)was 26.3 months(95%:22.8-29.7 months).The total recurrence rate and the out-field recurrence rate of the elective nodal irradiation(ENI)and involved-field irradiation(IFI)were 19.7%,1.6%and 17.9%3.8%respectively,which were no statistically significant difference(P>0.05).5.The univariate prognostic analysis showed that the T stage,N stage,TNM stage,tumor site,PS score,short-term efficacy,and radiation dosewere influencing factors for OS.However,patients’ gender,age,diabetes,hypertension,tumor site,radiotherapy technique and radiotherapy target area were not correlated with prognosis.The result of multivariate prognostic analysis indicated that TNM stage,short-term efficacy,radiation dose and tumor site were independent prognostic factors for with OS.Conclusions:Diabetes or hypertension might be risk factors of severe radiation esophagitis and pneumonitis in patients receiving radical radiotherapy.Diabetes is an independent factor of severe radiation pneumonia and esophagitis.ENI and IFI did not affect the prognosis of esophageal cancer.The result of multivariate prognostic analysis indicated that TNM stage,short-term efficacy,PS score and tumor site were independent prognostic factors for with OS.Part Ⅱ Analysis of adverse reactions and prognostic factors of esophageal cancer in aged≥70 yearsObjective:Esophageal cancer is one of the most common malignant tumors in China.Most of the elderly patients chose radiotherapy alone as the radical therapy because they could not tolerate surgery and chemotherapy.The obj ective of this study is to observe the side effects and long-term efficacy of elderly patients with esophageal cancer aged older than 70 years,to explore the effects of hypertension and diabetes on radiation esophagitis and lung injury,and to analyze the prognostic factors.Methods:From January 2008 to October 2018,341 patients at 4 cancer centers aged older than 70 years with esophageal squamous cell carcinoma who received radiotherapy alone were retrospectivelyincluded in this study,including 57 patients with type 2 diabetes and 140 patients with hypertension.To analyze the relationship between diabetes or hypertension and radiation esophagitis and pneumonia,the overall survival(OS)rates were calculated using the Kaplan-Meier method,survival difference analysis and univariate prognostic analysis were performed using the Log-rank test,and multivariate prognostic analysis were performed using Cox regression model.Results:1.The prevalence of grade Ⅰ,Ⅱ,Ⅲ and Ⅳ radiation esophagitis in diabetes and non-diabetes patients was 40.4%、38.6%、14.0%、7.0%and 65.1%、29.9%、3.9%、1.1%,respectively,while that for the grade Ⅰ,Ⅱ and Ⅲ radiation pneumonitis in diabetes and non-diabetes patients was 31.5%、17.5%、10.5%and 30.9%、15.8%,respectively.The prevalence of Ⅲ or above radiation esophagitis and pneumonitis in patients with diabetes and was significantly higher than those with non-diabetes(χ2=16.195,P<0.001 and X2=6.110,P=0.025).2.The prevalence of grade Ⅰ,Ⅱ,Ⅲ and Ⅳ radiation esophagitis in hypertension and non-hypertension patients was 49.3%、39.0%、9.3%、2.1%and 68.7%、26.4%、3.0%、2.0%,respectively,while that in the grade Ⅰ,Ⅱ and Ⅲ radiation pneumonitis in hypertension and non-hypertension patients were 30.0%、18.6%、7.9%and 35.3%、22.9%、1.5%,respectively.The prevalence of grade Ⅲ or above radiation esophagitis and pneumonitis in patients with hypertension was significantly higher than those with non-hypertension(χ2=4.880,P=0.027and χ2=8.491,P=0.005).3.The OS rates of 1,3 and 5 years were were 76.5%,42.0%and 23.9%,respectively,and the media survival time(MST)was 26.7 months(95%:22.1-31.8 months).The total recurrence rate and the out-field recurrence rate of the elective nodal irradiation(ENI)and involved-field irradiation(IFI)were 17.9%,1.30%and 16.0%,3.00%respectively,which were no statistically significant difference(P>0.05).4.The univariate prognostic analysis showed that the T stage,N stage,TNM stage,TNM stage,tumor site,PS score,short-term efficacy,and radiation dosewere influencing factors for OS.The result of multivariate prognostic analysis indicated that TNM stage,short-term efficacy,PS score and tumor site were independent prognostic factors for with OS.Conclusion:Diabetes or hypertension is a risk factor for esophageal and pulmonary injury of grade 3 or over.The prognosis was not affected by IFI radiotherapy in elderly patients,and TNM stage,short-term efficacy,PS score and tumor site were independent prognostic factors for survival. |
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