Abstract：Objective To compare the efficacy between three-dimensional radiotherapy (3DRT) combined with chemotherapy and radiotherapy alone for patients with esophageal squamous cell carcinoma.Methods A retrospective analysis was performed for 1257 patients with esophageal squamous cell carcinoma who were admitted to our hospital from July 2003 to June 2012 and met the inclusion criteria;362 patients were treated with 3DRT combined with chemotherapy (chemoradiotherapy group) and 895 patients were treated with radiotherapy alone (radiotherapy group). The short-term outcome, overall survival (OS) rate, and causes of death were analyzed. The Kaplan-Meier method was used to calculate survival rates, and the log-rank test was used for survival difference analysis and univariate prognostic analysis. Results The response rate was 99.1%(346/349) in the chemoradiotherapy group and 99.0%(813/821) in the radiotherapy group (P=0.397). The 1-, 3-, and 5-year OS rates were 74.0%,42.0%,and 32.9% in the chemoradiotherapy group and 65.9%,33.0%,and 23.3% in the radiotherapy group (P=0.000), and were 75.6%,43.5%,and 33.2% in the concurrent chemoradiotherapy group and 65.9%,33.0%,and 23.3% in the radiotherapy group (P=0.000). There were no significant differences in 1-, 3-, and 5-year OS rates between the concurrent chemoradiotherapy group and the sequential chemoradiotherapy group (P=0.583). The sequential chemoradiotherapy group had an insignificant increase in 1-, 3-, and 5-year OS rates compared with the radiotherapy group (P=0.065). Tumor recurrence and local control failure were the main causes of death, followed by distant metastasis. The chemoradiotherapy group had a significantly lower proportion of patients who died of local control failure than the radiotherapy group (7.4% vs. 14.7%, P=0.003). Conclusions For patients with esophageal squamous cell carcinoma, chemoradiotherapy leads to significantly improved overall survival compared with radiotherapy alone;compared with radiotherapy alone, sequential chemoradiotherapy results in an increasing trend in OS rates, while concurrent chemoradiotherapy results in significantly increased OS rates. Chemoradiotherapy can reduce the deaths due to local control failure compared with radiotherapy alone.
Zhand Andu,Han Jing,Han Chun et al. Clinical effect of three-dimensional radiotherapy combined with chemotherapy for esophageal squamous cell carcinoma:a study of 1257 patients[J]. Chinese Journal of Radiation Oncology, 2017, 26(5): 517-521.
[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[J].中华放射肿瘤学杂志,2010,19(3):179-180.DOI:0.3760/cma.j.issn.1004-4221.2010.03.001. Expert group on clinical staging of non operative treatment of esophageal cancer in China. Clinical staging criteria for non operative treatment of esophageal cancer[J].Chin J Radiat Oncol,2010,19(3):179-180.DOI:10.3760/cma.j.issn.1004-4221.2010.03.001. [2] 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.isan.1004-4221.2011.02.008. Han C,Wang L,Zhu SC,et al. Evaluation of clinical staging criteria for esophageal cancer in 225 patients with radiotherapy[J].Chin J Radiat Oncol,2011,20(2):109-112.DOI:10.3760/cma.j.isan.1004-4221.2011.02.008. [3] 王澜,孔洁,韩春,等.非手术治疗食管癌临床分期标准的临床应用与探讨[J].中华放射肿瘤学杂志,2012,21(4):330-333.DOI:10.3760/ema.j.issn.1004-4221.2012.04.012 Wang L,Kong J,Han C,et al. Clinical application and discussion of the clinical staging criteria of non operative treatment of esophageal carcinoma[J].Chin J Radiat Oncol,2012,21(4):330-333.DOI:10.3760/ema.j.issn.1004-4221.2012.04.012. [4] 李辉.食管癌术前分期的现状及进展[J].中华胸心血管外科杂志,2003,19(1):1-3. Li H.Current status and progress of preoperative staging of esophageal carcinoma[J].Chin J Thora Cardiovascul Surg,2003,19(1):1-3. [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. Gu YJ,Wang JH,Xiang JQ,et al. Objective to investigate the clinical significance of CT in the detection of tracheoesophageal groove lymph node metastasis in thoracic esophageal carcinoma[J].Chin J Radiol,2002,36(2):139-141. [6] 万钧,肖爱勤,高淑珍,等.食管癌放疗后近期疗效评价标准[J].中国放射肿瘤学,1989,3(4):205-207. Wan J,xiao AQ,Gao SZ,et al. Evaluation criteria for short-term efficacy of radiotherapy for esophageal cancer[J].Chin J Radiat Oncol,1989,3(4):205-207. [7] 肖泽芬.食管癌[A]//殷蔚伯,谷铣之,主编.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 XZ.Radiation Oncology[M].3 ed. Beijing:Peking Union Medical College press,2002:598-620. [8] 王澜,韩春,李晓宁,等.中晚期食管癌3DCRT联合同期化疗的临床观察[J].中华肿瘤防治杂志,2010,(24):2053-2056.DOI:10.16073/j.cnki.cjcpt.2010.24.015. Wang L,Han C,Li XG,et al. Clinical observation of 3DCRT combined with concurrent chemotherapy for advanced esophageal carcinoma[J].Chin J Cancer Prevent Treat,2010(24):2053-2056.DOI:10.16073/j.cnki.cjcpt.2010.24.015. [9] 韩晶,王澜,韩春,等.食管癌同期放化疗的临床观察[J].中华肿瘤防治杂志,2011(23):1859-1863.DOI:10.16073/j.cnki.cjcpt.2011.23.015. Han J,Wang L,Han C,et al. Clinical observation of concurrent chemoradiotherapy for esophageal carcinoma[J].Chin J Cancer Prevent Treat,2011(23):1859-1863.DOI:10.16073/j.cnki.cjcpt.2011.23.015. [10] Cooper J S,Guo M D,Herskovic A,et al. Chemoradiotherapy of locally advanced esophageal cancer:long-term follow-up of a prospective randomized trial (RTOG 85-01).Radiation Therapy Oncology Group[J].JAMA,1999,281(17):1623-1627. [11] 赵永军,焦会芝.PFL方案同步放射治疗中晚期食管癌前瞻性随机分组临床探讨[J].中国肿瘤临床,2008(11):611-612+616. Zhao YJ,Jiao HZ.Clinical study of PFL regimen in the treatment of advanced esophageal cancer with synchronous radiotherapy[J].Chin J Clin Oncol,2008(11):611-612+616. [12] Wong RK,Malthaner R.Withdraw N.Combined chemotherapy and radiotherapy (without surgery) compared with radiotherapy alone in localized carcinoma of the esophagus[J].Cochrane Database Syst Rev,2010(1):CD002092.DOI:10.1002/14651858.CD002092. [13] Kim DE,Kim UJ,Choi WY,et al. Clinical prognostic factors for locally advanced esophageal squamous carcinoma treated after definitive chemoradiotherapy[J].Cancer Res Treat,2013,45(4):276-284.DOI:1598-2998/2005-9256. [14] Tsujino K,Kurata T,Yamamoto S,et al. Is consolidation chemotherapy after concurrent chemo-radiotherapy beneficial for patients with locally advanced non-small-cell lung cancer? A pooled analysis of the literature[J].J Thorac Oncol,2013,8(9):1181-1189.DOI:1556-0864/13/0809-1181. [15] 王澜,孔洁,韩春,等.781例不同部位食管癌3DCRT预后分析[J].中华放射肿瘤学杂志,2013,22(1):18-21.DOI:10.3760/cma.j.issn.1004-4221.2013.01.006. Wang L,Kong J,Han C,et al. Prognostic analysis of 3DCRT in 781 patients with esophageal carcinoma[J].Chin J Radiat Oncol,2013,22(1):18-21.DOI:10.3760/cma.j.issn.1004-4221.2013.01.006. [16] 张安度,韩春,兰堃田,等.食管鳞癌3DCRT患者年龄与预后分析[J].中华放射肿瘤学杂志,2014,(23):392-395.DOI:10.3760/cma.j.issn.1004-4221.2014.05.006. Zhang AD,Han C,Lan KT,et al. Age and prognosis of patients with esophageal squamous cell carcinoma 3DCRT[J].Chin J Radit Oncol,2014,(23):392-395.DOI:10.3760/cma.j.issn.1004-4221.2014.05.006. [17] 陈尔成,刘孟忠,胡永红,等.食管癌同期放化疗后局部失败相关因素分析[J].癌症,2005(4):498-501. Chen EC,Liu MZ,Hu YH,et al. Factors related to local failure after concurrent chemoradiotherapy for esophageal carcinoma[J].Chin J Cancer,2005(4):498-501.
2017, Vol. 26 
