Clinical efficacy of dose escalation in 3-dimensional radiotherapy for patients with esophageal squamous cell carcinoma-multicenter retrospective analysis (3JECROG R-03)
Zhao Jingjing1, Zhang Wencheng1, Zhang Hualei1, Han Weiming2, Wang Xin2, Li Chen2, Chen Junqiang3, Wang Xiaomin4, Zhao Yidian4, Qiao Xueying5, Zhou Zhiguo5, Han Chun5, Zhu Shuchai5, Shen Wenbin5, Wang Lan5, Ge Xiaolin6, Sun Xinchen6, Zhang Kaixian7, Hu Miaomiao7, Li Ling7, Hao Chongli7, Li Gaofeng8, Xu Yonggang8, Wang Yadi9, Lu Na9, Liu Miaoling10, Qie Shuai10, Xiao Zefen2, Pang Qingsong1, Wang Ping1
1Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tian Jin, Tianjin’s Clinical Research Center for Cancer, Tianjin 300060, China; 2Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China; 3Department of Radiation Oncology, Fujian Cancer Hospital/Fujian Medical University Cancer Hospital, Fuzhou 350014, China; 4Department of Radiation Oncology, Anyang Cancer Hospital, Anyang 455000, China; 5Department of Radiation Oncology, the Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China; 6Department of Radiation Oncology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China; 7Department of Oncology, Tengzhou Central People′s Hospital, Tengzhou 277599, China; 8Department of Radiation Oncology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China; 9Department of Radiation Oncology, the Seventh Medical Center of PLA General Hospital, Beijing 100700, China; 10Department of Radiation Oncology, Affiliated Hospital of Hebei University, Baoding 071000, China
Abstract：Objective To evaluate the effect of definitive radiotherapy with different doses on overall survival (OS) and identify the prognostic factors of patients with non-metastatic esophageal squamous cell carcinoma (ESCC). Methods Clinical data of 2344 ESCC patients treated with definitive radiotherapy (RT) alone or chemoradiotherapy from 2002 to 2016 in 10 hospitals were collected and analyzed retrospectively. After the propensity score matching (PSM)(1 to 2 ratio), all patients were divided into the low-dose group (equivalent dose in 2Gy fractions,EQD2Gy<60 Gy;n=303) and high-dose group (EQD2Gy≥60 Gy;n=606) based on the dose of radiation. Survival analysis was conducted by Kaplan-Meier method. Multivariate prognostic analysis was performed by Cox′s regression model. Results The median follow-up time was 59.6 months. After the PSM, the 1-, 3- and 5-year overall survival (OS) rate was 66.5%,34.7%,27.2% in the low-dose group, 72.9%,41.7% and 34.7% in the high-dose group, respectively (P=0.018). The 1-, 3-and 5-year progression-free survival rate was 52.2%,27.2%,23.1% in the low-dose group, 58.3%,38.1% and 33.9% in the high-dose group, respectively (P=0.001). The outcomes of univariate analysis indicated that cervical/upper esophagus location, early (stage Ⅱ) AJCC clinical stage, node negative status, tumor length ≤5 cm, receiving intensity-modulated radiation therapy (IMRT), receiving concurrent chemotherapy and EQD2Gy≥60Gy were closely associated with better OS (all P<0.05). Multivariable analysis demonstrated that tumor location, regional lymph node metastasis, concurrent chemotherapy and EQD2Gy were the independent prognostic factors for OS (all P<0.05). Conclusion Three-dimensional conformal or IMRT with EQD2Gy≥60Gy yields favorable survival outcomes for patients with locally advanced ESCC.
Zhao Jingjing,Zhang Wencheng,Zhang Hualei et al. Clinical efficacy of dose escalation in 3-dimensional radiotherapy for patients with esophageal squamous cell carcinoma-multicenter retrospective analysis (3JECROG R-03)[J]. Chinese Journal of Radiation Oncology, 2020, 29(11): 941-947.
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