Benefit Analysis Of Concurrent Radiotherapy And Chemotherapy And Radiotherapy Alone For Esophageal Squamous Cell Carcinoma

Objective: To compare the survival benefit of concurrent chemoradiotherapy in comparison with radiotherapy alone in esophageal squamous cell carcinoma(ESCC)in a real-world patient population.Methods: This retrospective study analyzed 1418 patients with esophageal cancer who met the inclusion criteria for concurrent chemoradiotherapy or radiotherapy alone in the fourth hospital of hebei medical university from july 2003 to november 2013.The radiotherapy alone group and concurrent chemoradiotherapy group were respectively included 341 and 1077 patients.SPSS22.0 software was used to match the baseline characteristics of the enrolled patients with propensity-score matching(PSM).Finally,each group was ended up with 330 patients in this study.Survival benefits between the two groups were analyzed by Kaplan-Meier method.Results: After 21.5 months of median follow-up(0.8-182.4 months),the median overall survival of the concurrent chemoradiotherapy and radiotherapy alone groups were respectively 28.6 months and 24.0 months.The overall survival(OS)benefit of the concurrent chemoradiotherapy group was significantly increased(P=0.005).Multivariate analysis showed that concurrent chemoradiotherapy,sex,age,lesion location,clinical T、N stage,tumor volume and irradiation dose were the independent prognostic factors of OS and the other above factors were also independent prognostic factors of progression-free survival(PFS)except concurrent chemoradiotherapy.The baseline characteristics of the patients in the two groups after the propensity-score matching were well balanced(P>0.05).Survival analysis showed that the median OS and median PFS of the two groups were respectively 28.5 months,25.1 months and 19.6,19.4 months.The overall survival of the concurrent chemoradiotherapy group was significantly higher than that of the radiotherapy alone group(P=0.044),but there was no significant difference in the Progression-free survival(P=0.480).Multivariate analysis showed that concurrent chemoradiotherapy,sex,clinical T、N stage and irradiation dose were the independent prognostic factors of OS and sex,age,clinical T、N stage and irradiation dose were the independent prognostic factors of PFS.Subgroup analysis showed that patients ≤70 years of age benefit significantly in OS and PFS who accepted concurrent chemoradiotherapy;Patients>70 years of age had no difference in survival benefits between the two treatments.Patients with irradiation dose ≥60 Gy in radiotherapy alone group was significantly better in OS and PFS,and the increase of radiation dose in patients with concurrent chemoradiotherapy group did not benefit in OS,but the survival benefit of patients with irradiation dose of 60 Gy was obvious in PFS.Conclusions: Retrospective analysis showed that the long-term survival of simultaneous radiotherapy and chemotherapy was better than that of simple radiotherapy,in which patients with esophageal squamous cell carcinoma aged ≤70 had significant OS、PFS benefits after receiving simultaneous radiotherapy and chemotherapy,while those aged >70 had no significant survival benefits.There was a dose-to-effect relationship in patients with esophageal squamous cell carcinoma who received 60 Gy irradiation dose in the radiotherapy group alone had OS and PFS benefits,and patients who received 60 Gy irradiation dose in the concurrent radiotherapy and chemotherapy group had PFS benefit.But there is still a lot of research and data needed to further explore the effects of age,radiation dose and other factors in the impact.