Postoperative adjuvant three-dimensional conformal radiotherapy improves long-term survival in patients with pathological T2－3N0M0 esophageal cancer
Yang Jinsong*, Zhang Wencheng, Xiao Zefen, Zhou Zongmei, Zhang Hongxing, Chen Dongfu, Feng Qinfu, He Jie, Gao Shugeng, Sun Kelin, Liu Xiangyang, Fang Dekang, Mu Jyuwei, Wang Dali
*Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College,Beijing 100021,China
Abstract：Objective To assess the clinical value of three-dimensional conformal radiotherapy (3DRT) in postoperative adjuvant therapy after initial radical surgery for pathological T2－3N0M0 thoracic esophageal squamous cell carcinoma (pT2－3N0M0 TESCC). Methods The recurrence, survival, and radiotherapy adverse events in 96 patients with pT2－3N0M0 TESCC who received adjuvant 3DRT after radical surgery from a prospective nonrandomized phase Ⅱ clinical study from 2004 to 2011 were compared with those in 820 patients undergoing surgery alone. The survival rate was determined by the Kaplan-Meier method and analyzed using the log-rank test. Multivariate prognostic analysis was performed using the Cox proportional hazard model. Results Postoperative 3DRT group had a significantly higher ratio of patients with tumor length ≥5 cm and stage T3 than surgery alone group. The 5-year sample sizes for the postoperative 3DRT and surgery alone groups were 35 and 270, respectively. The 5-year overall survival (OS) and disease-free survival (DFS) rates for the postoperative 3DRT versus surgery alone group were 74.3% vs. 59.9%(P=0.010) and 71.0% vs. 51.7%(P=0.002), respectively. Multivariate analysis revealed that 3DRT was independently associated with an improved OS (P=0.030) and DFS (P=0.004). The overall recurrence rate, locoregional recurrence rate, and distant metastasis rate in the postoperative 3DRT group versus surgery alone group were 22.9% vs. 43.0%(P=0.000), 18.8% vs. 35.2%(P=0.001), and 11.5% vs. 21.3%(P=0.024), respectively. Both early and late grade 3 adverse events developed in 25 patients (26.0%) in the postoperative 3DRT group. Conclusions Compared with surgery alone, postoperative adjuvant 3DRT reduces the recurrence rate and improves the 5-year DFS and OS with tolerable adverse effects in patients with pT2－3N0M0 TESCC. Prospective randomized phase Ⅲ clinical study is still needed.
Yang Jinsong,Zhang Wencheng,Xiao Zefen et al. Postoperative adjuvant three-dimensional conformal radiotherapy improves long-term survival in patients with pathological T2－3N0M0 esophageal cancer[J]. Chinese Journal of Radiation Oncology, 2015, 24(2): 101-105.
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