IMRT/3DCRT治疗Ⅱ/Ⅲ期食管鳞癌疗效和预后分析——泛京津冀多中心回顾分析(3JECROG R-06)

doi:10.3760/cma.j.issn.1004-4221.2019.06.002

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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.

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Key words： Esophageal neoplasm/three-dimensional conformal radiotherapy Esophageal neoplasm/intensity-modulated radiotherapy Prognosis

Received: 16 January 2019

Fund:Beijing Marathon of Hope Foundation of Cancer Foundation of China (LC2016L04)

Corresponding Authors: Li Gaofeng,Email:lgf6243@163.com;Xiao Zefen,Email:xiaozefen@sina.com

Cite this article:

. 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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http://journal12.magtechjournal.com/Jweb_fszlx/EN/10.3760/cma.j.issn.1004-4221.2019.06.002 OR http://journal12.magtechjournal.com/Jweb_fszlx/EN/Y2019/V28/I6/405

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