Abstract：Objective To investigate the clinical features of esophageal cancer patients with long-term survival after precise radiotherapy, related factors for treatment, and the conditions for survival benefits, and to provide a reference for clinical practice. Methods A retrospective analysis was performed for 913 patients with esophageal cancer who received single-dose radiotherapy from 2003 to 2009. The clinical features, related factors for chemoradiotherapy, adverse events, and short-term therapeutic effect were compared between long-term survival group (a survival time of ≥60 months) and non-long-term survival group, and a prognostic analysis was performed. The chi-square test was used for comparison between groups, the Kaplan-Meier method was used to calculate survival rates, the log-rank test was used for survival difference analysis, and the Cox proportional hazards model was used for multivariate prognostic analysis. Results There were 217 patients in the long-term survival group and 696 in the non-long-term survival group. There were differences in sex, tumor location, length of lesions, transverse diameter, surrounding invasion, non-surgical stage, and gross tumor volume (GTV) between the two groups (P=0.010,0.002,0.000,0.000,0.000,0.000,0.000). The 1-, 3-, 5-, 7-, and 9-year overall survival rates were 72.5%, 35.3%, 25.8%, 19.1%, and 13.9%, respectively, and the median survival time was 21 months. Compared with the non-long-term survival group, the long-term survival group showed a shorter course of radiotherapy and better dose-volume parameters including GTV and planning target volume, and GTV D100 and D95 showed differences between the two groups (P=0.024 and 0.024). Compared with the non-long-term survival group, more patients in the long-term survival group received concurrent chemotherapy and showed a higher degree of acute esophagitis and a better short-term outcome (P=0.018 and 0.000), while no patient experienced extremely severe pneumonia. The patients with a prescribed dose of less than 60 Gy showed worse survival rates than those with a prescribed dose of ≥60 Gy (P=0.027), and the patients receiving concurrent chemoradiotherapy showed better survival rates than those who did not receive concurrent chemoradiotherapy (P=0.076). The multivariate analysis with the Cox proportional hazards model indicated that tumor location, non-surgical stage, GTV, cycles of chemotherapy, and short-term therapeutic effect were independent prognostic factors. Conclusions There are complex prognostic factors for non-surgical treatment for esophageal cancer, and the stage of disease progression determines the prognosis to a large extent. Meanwhile, radiotherapy with a dose of ≥60 Gy, high-quality treatment plan, concurrent chemotherapy, and good tumor response to treatment are factors for survival benefit.
Wang Lan,Han Chun,Liu Lihong et al. Clinical features of esophageal cancer patients with long-term survival and related factors for treatment [J]. Chinese Journal of Radiation Oncology, 2016, 25(6): 565-570.
[1] 中国非手术治疗食管癌临床分期专家小组.非手术治疗食管癌的临床分期标准(草案)[J].中华放射肿瘤学杂志,2010,19(3):179-180.DOI:10.3760/cma.j.issn.1004-4221.2010.03.001.China non operative treatment of esophageal cancer clinical staging expert group. Standard for clinical staging of non operative treatment for esophageal cancer (Draft)[J].Chin J Radiat Oncol,2010,19(3):179-180.DOI:10.3760/cma.j.issn.1004-4221.2010.03.001. [2] 王澜,高超,李晓宁,等.100例食管癌三维适形放疗疗效分析[J].中华放射肿瘤学杂志,2009,18(5):375-378.DOI:10.3760/cma.j.issn.1004-4221.2009.05.375. Wang L,Gao C,Li XN,et al. Treatment outcomes of three-dimensional conformal radiotherapy for esophageal carcinoma[J].Chin J Radiat Oncol,2009,18(5):375-378.DOI:10.3760/cma.j.issn.1004-4221.2009.05.375. [3] 韩春,王澜,祝淑钗,等.非手术治疗食管癌临床分期标准对225例放疗患者的预后评价[J].中华放射肿瘤学杂志,2011,20(2):109-112.DOI:10.3760/cma.j.issn.1004-4221.2011.02.008. Han C,Wang L,Zhu SC,et al. Evaluation of prognosis of clinical staging for esophageal carcinoma treated with non-surgical methods-addition with analysis of 225 patients[J].Chin J Radiat Oncol,2011,20(2):109-112.DOI:10.3760/cma.j.issn.1004-4221.2011.02.008. [4] 李辉.食管癌术前分期的现状和进展[J].中华胸心血管外科杂志,2003,19(1):1-3.DOI:10.3760/cma.j.issn.1001-4497. 2003.01.001.Li H. Current status and progress of preoperative staging of esophageal carcinoma[J].Chin J Thora Cardiovascul Surg,2003,19(1):1-3.DOI:10.3760/cma.j.issn.1001-4497. 2003.01.001. [5] 顾雅佳,王玖华,相加庆,等.CT观察胸段食管癌气管食管沟淋巴结转移的临床意义探讨[J].中华放射学杂志,2002,36(2):139-141.DOI:10.3760/j.issn:1005-1201.2002.02.014. Gu YJ,Wang JH,Xiang JQ,et al. A study on clinical value of CT features of tracheoesophageal groove lymph node metastasis of thoracic esophageal carcinoma[J].Chin J Radiol,2002,36(2):139-141.DOI:10.3760/j.issn:1005-1201. 2002.02.014. [6] Van Overhagen H,Laméris JS,Berger MY,et al. Supraclavicular lymph node metastases in carcinoma of the esophageal and gastroesophageal junction:assessment with CT,US and US-guided fine-needle aspiration biopsy[J].Radiology,1991,179(1):155-158.DOI:10.1148/radiology.179.1.2006268. [7] Mizowaki T,Nishimura Y,Shimada Y,et al. Optimal size criteria of malignant lymph nodes in the treatment planning of radiotherapy for esophageal cancer:evaluation by computed tomography and magnetic resonance imaging[J].Int J Radiat Oncol Biol Phys,1996,36(5):1091-1098.DOI:10.1016/S0360-3016(96)00425-7. [8] 肖泽芬,食管癌[A]//殷蔚伯,谷铣之.肿瘤放射治疗学[M].3版.北京:中国协和医科大学出版社,2002:598-620.Xiao ZF.Esophageal cancer[A]//Yin WB,Gu XZH.Radiation oncology[M].3,ed. Beijing:Peking Union Medical College press,2002:598-620. [9] Delcambre C,Jacob JH,Dottier D,et al. Localized squamous-cell cancer of the esophagus:retrospective analysis of three treatment schedules[J].Radiother Oncol,2001,59(2):195-201.DOI:10.1016/S0167-8140(01)00307-3. [10] 万钧,刘明,韩春,等.食管癌放疗剂量研究的十年结果[J].中华放射肿瘤学杂志,1996,5(3):58. Wan J,Liu M,Han CH,et al. Ten year results of radiotherapy for esophageal cancer[J].Chin J Radiat Oncol,1996,5(3):58.
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