Comparison of clinical efficacy and prognosis of intensity-modulated radiotherapy and three dimensional conformal radiotherapy in patients with stage Ⅱ/Ⅲ esophageal cancer:a multi-center retrospective analysis in Beijing, Tianjin and Hebei province (3JECROG R-06)
Xu Yonggang1, Wang Xin2, Li Chen2, Wang Lan3, Han Chun3, Chen Junqiang4, Zhang Wencheng5, Wang Xiaomin6, Ge Xiaolin7, Shen Wenbin3, Hu Miaomiao8, Yuan Qianqian8, Hao Chongli8, Zhou Zhiguo3, Qie Shuai9, Lu Na10, Pang Qingsong5, Wang Ping5, Zhao Yidian6, Sun Xinchen7, Zhang Kaixian8, Li Ling8, Qiao Xueying3, Liu Miaoling9, Wang Yadi10, Zhu Shuchai3, Chen Dazhi1, Wu Qinhong1, Gao Hong1, Xiu Xia1, Li Gaofeng1, Xiao Zefen2
1Department of Radiation Oncology,Beijing Hospital,National Center of Gerontology,Beijing 100730,China; 2Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences ( CAMS ) and Peking Union Medical College ( PUMC),Beijing 100021,China; 3Department of Radiation Oncology,Fourth Hospital of Hebei Medical University,Shijiazhuang 050011,China; 4Department of Radiation Oncology,Fujian Cancer Hospital/Fujian Medical University Cancer Hospital,Fuzhou 350014,China; 5Department of Radiation Oncology,Tianjin Medical University Cancer Institute and Hospital/National Clinical Research Center for Cancer,Tianjin 300060,China; 6Department 4th of Radiation Oncology,Anyang Cancer Hospital,Anyang 455000,China; 7Department of Radiation Oncology,First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China; 8Department of Oncology,Tengzhou Central People′s Hospital,Tengzhou 277599,China; 9Department of Radiation Oncology,Affiliated Hospital of Hebei University,Baoding 071000,China; 10Department of Radiation Oncology,PLA Army General Hospital,Beijing 100700,China
Abstract：Objective To compare the therapeutic effects between three-dimensional conformal radiotherapy (3DCRT) and intensity-modulated radiotherapy (IMRT) in patients with stage Ⅱ/Ⅲ esophageal cancer and investigate the prognostic factors.Methods Medical record of 2132 patients with stage Ⅱ/Ⅲ esophageal cancer who underwent definitive radiotherapy with/without chemotherapy in 10 hospitals from January 2002 to December 2016 from were retrospectively analyzed. Among these patients, 37.9% of them were aged≥70 years, 33.9% with neck and upper esophageal tumors and 66.1% with middle and lower esophageal and borderline tumors. The median gross tumor volume (GTV) and lymph node gross tumor volume (GTVnd) was 41.6 cm3.Among them, 32% were stage Ⅱ and 68% were stage Ⅲ.A total of 723 patients received 3DCRT and 1409 cases received IMRT.Patients received an equivalent dose in 2 Gy (EQD2) ≥ 60 Gy accounted for 86.1%, and 41.1% of them received concurrent chemoradiotherapy.Results The median follow-up time was 60.8 months. The 1-, 3-and 5-year overall survival (OS) of all patients was 73.9%, 41.7% and 32.6%, and the 1-, 3-and 5-year progression-free survival (PFS) was 62.2%, 37.3% and 32%, respectively. Multivariate analysis demonstrated that age, primary tumor location, clinical stage, tumor target volume, EQD2 and concurrent chemoradiotherapy were the independent prognostic factors for OS.Age, primary tumor location, clinical stage, tumor target volume and EQD2 were the independent prognostic factors for PFS.The OS and PFS did not significantly differ among the low-risk, low-/moderate-risk, moderate-/high-risk and high-risk groups according to age≥70 years, tumor diameter>5 cm, tumor volume≥41.6 cm3and stage Ⅲ(P<0.001).After the propensity score matching (PSM) method, neither 3DCRT nor IMRT yielded significant advantages in OS or PFS (P=0.971;P=0.658).However, IMRT tended to yield survival benefits in low-risk patients (P=0.125).Conclusions Both 3DCRT and IMRT yield relatively high OS rate in patients with stage Ⅱ/Ⅲ esophageal cancer. The prognosis model established in this investigation can properly predict the survival of patients. Low-risk patients tend to obtain survival benefits from IMRT.
. Comparison of clinical efficacy and prognosis of intensity-modulated radiotherapy and three dimensional conformal radiotherapy in patients with stage Ⅱ/Ⅲ esophageal cancer:a multi-center retrospective analysis in Beijing, Tianjin and Hebei province (3JECROG R-06)[J]. Chinese Journal of Radiation Oncology, 2019, 28(6): 405-411.
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2019, Vol. 28 
