AbstractObjective To compare the local control (LC), long-term overall survival (OS), and clinical adverse reactions in esophageal carcinoma patients receiving concurrent chemoradiotherapy at different radiotherapy doses. Methods A total of 373 esophageal carcinoma patients who received concurrent chemoradiotherapy in our hospital during 2004-2013 were included in this retrospective study. These patients were divided into<60 Gy group (n=99), 60 Gy group (n=155), and>60 Gy group (n=119) based on the dose of radiation. The Kaplan-Meier method was used to calculate LC and OS rates;the log-rank test was used for survival comparison and univariate prognostic analysis;the Cox model was used for multivariate prognostic analysis. Results The 3-, 5-, 7-, and 10-year sample sizes were 97,96,56, and 38 in the<60 Gy group, 146,141,72, and 17 in the 60 Gy group, and 118,115,56, and 20 in the>60 Gy group. The 3-, 5-, 7-, and 10-year LC rates were 55.3%, 51.4%, 48.9%, and 48.9% in the<60 Gy group, 65.1%, 60.1%, 55.1%, and 55.1% in the 60 Gy group, and 49.4%, 45.1%, 37.7%, and 37.7%(8-year) in the>60 Gy group (P=0.020). The 3-, 5-, 7-, and 10-year OS rates were 35.4%, 26.1%, 22.0%, and 22.0% in the<60 Gy group, 49.0%, 41.3%, 32.1%, and 28.9% in the 60 Gy group, and 31.1%, 25.2%, 14.5%, and 12.9%(8-year) in the>60 Gy group (P=0.000). The univariate analysis showed that for stage Ⅱ esophageal carcinoma patients with gross tumor volume (GTV) ≤44 cm3, the LC rate was higher in the 60 Gy group than in the<60 Gy group (P=0.040,0.035), and the OS rate was higher in the 60 Gy group than in the other two groups (P=0.001,0.003 and P=0.045,0.006). Similarly, for stage Ⅲ esophageal carcinoma patients with GTV>44 cm3, the LC rate was higher in the 60 Gy than in the>60 Gy group (P=0.011,0.015), and the OS rate was higher in the 60 Gy group than in the other two groups (P=0.045,0.006 and P=0.033,0.002). The incidence rates of acute radiation esophagitis and radiation pneumonia were significantly higher in the>60 Gy group than in the other two group (P=0.007,0.033). Furthermore, the multivariate analysis indicated that radiotherapy dose, T stage, and N stage were independent prognostic factors for esophageal carcinoma (P=0.004,0.008,0.037). Conclusions Concurrent chemoradiotherapy at 60 Gy is most efficacious for patients with esophageal carcinoma, and the radiotherapy dose of>60 Gy significantly increases the incidence of adverse reactions.
Corresponding Authors:
Han Chun,Email:hanchun2006@126.com
Cite this article:
Ren Xuejiao,Wang Lan,Han Chun et al. Long-term efficacy of concurrent chemoradiotherapy at different radiotherapy doses in treatment of esophageal carcinoma[J]. Chinese Journal of Radiation Oncology, 2017, 26(9): 1006-1011.
Ren Xuejiao,Wang Lan,Han Chun et al. Long-term efficacy of concurrent chemoradiotherapy at different radiotherapy doses in treatment of esophageal carcinoma[J]. Chinese Journal of Radiation Oncology, 2017, 26(9): 1006-1011.
[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.Chinese expert group on clinical staging of non-surgical treatment of esophageal cancer:standard clinical staging criteria for non-surgical treatment of 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] 万钧,肖爱勤,高淑珍,等.食管癌放疗后近期疗效评价标准——附1000例分析[J].中国放射肿瘤学,1989,3(4):205-207. Wan J,Xiao AQ,Gao SZ,et al. Evaluation criteria of short-term efficacy after radiotherapy for esophageal carcinoma:an analysis of 1000 cases[J].Chin Radit Oncol,1989,3(4):205-207. [3] 韩春,任雪姣,王澜,等.钡餐造影结合CT评价食管癌放疗近期疗效的研究[J].中华放射肿瘤学杂志,2013,22(1):26-29.DOI:10.3760/cma.j.issn.1004-4221.2013.01.008. Han C,Ren XJ,Wang L,et al. Evaluating short-term radiotherapeutic effect on esophageal cancer by barium meal combined with CT scans[J].Chin J Radiat Oncol,2013,22(1):26-29.DOI:10.3760/cma.j.issn.1004-4221.2013.01.008. [4] Chen CY,Li CC,Chien CR.Does higher radiation dose lead to better outcome for non-operated localized esophageal squamous cell carcinoma patients who received concurrent chemoradiotherapy? A population based propensity-score matched analysis[J].Radiother Oncol,2016,120(1):136-139.DOI:10.1016/j.radonc.2016.04.042. [5] Song T,Liang XD,Fang M,et al. High-dose versus conventional-dose irradiation in cisplatin-based definitive concurrent chemoradiotherapy for esophageal cancer:a systematic review and pooled analysis[J].Expert Rev Anticancer Ther,2015,15(10):1157-1169.DOI:10.1586/14737140.2015.1074041. [6] Brower JV,Chen S,Bassetti MF,et al. Radiation dose escalation in esophageal cancer revisited:a contemporary analysis of the national cancer data base,2004 to 2012[J].Int J Radiat Oncol Biol Phys,2016,96(5):985-993.DOI:10.1016/j.ijrobp.2016.08.016. [7] 孔洁,李晓宁,韩春,等.792例食管癌三维技术放疗的疗效分析[J].中华放射肿瘤学杂志,2012,21(5):421-424.DOI:10.3760/cma.j.issn.1004-4221.2012.05.007. Kong J,Li XN,Han C,et al. Treatment outcomes of 792 cases of esophageal carcinoma patients treated with three-dimensional radiotherapy[J].Chin J Radiat Oncol,2012,21(5):421-424.DOI:10.3760/cma.j.issn.1004-4221.2012.05.007. [8] 王澜,李晓旭,韩春,等.食管癌长期OS患者临床特征及治疗相关因素分析[J].中华放射肿瘤学杂志,2016,25(6):565-570.DOI:10.3760/cma.j.issn.1004-4221.2016.06.005. Wang L,Li XX,Han C,et al. Clinical features of esophageal cancer patients with long-term survival and related factors for treatment[J].Chin J Radiat Oncol,2016,25(6):565-570.DOI:10.3760/cma.j.issn.1004-4221.2016.06.005. [9] 任雪姣,刘丽虹,王澜,等.548例食管癌3DRT的GTV受量分析与预后[J].中华放射肿瘤学杂志,2016,25(11):1172-1176.DOI:10.3760/cma.j.issn.1004-4221.2016.11.006. Ren XJ,Liu LH,Wang L,et al. Gross tumor volume dosimetry and prognosis of esophageal carcinoma treated with three-dimensional radiotherapy:a study of 548 patients[J].Chin J Radiat Oncol,2016,25(11):1172-1176.DOI:10.3760/cma.j.issn.1004-4221.2016.11.006. [10] 王澜,孔洁,韩春,等.781例不同部位食管癌三维放疗预后分析[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 cervical,upper-thoracic,middle-thoracic,and lower-thoracic esophageal cancers in 781 patients mainly receiving three-dimensional radiotherapy[J].Chin J Radiat Oncol,2013,22(1):18-21.DOI:10.3760/cma.j.issn.1004-4221.2013.01.006. [11] Minsky BD,Pajak TF,Ginsberg RJ,et al. INT 0123(Radiation Therapy Oncology Group 94-05) phase Ⅲ trial of combined-modality therapy for esophageal cancer:high-dose versus standard-dose radiation therapy[J].J Clin Oncol,2002,20(5):1167-1174.DOI:10.1200/JCO.2002.20.5.1167. [12] 赵快乐,施学辉,蒋国梁.提高食管癌的放射治疗剂量是否有益?—食管癌三维适形放疗临床I/Ⅱ期剂量递增试验[J].中国癌症杂志,2008,18(5):354-357.DOI:10.3969/j.issn.1007-3639.2008.05.007. Zhao KL,Shi XH,Jiang GL.Do the patients with esophageal cancer benefit from higher radiation dose?—Dose escalation of 3-D conformal radiation therapy in the patients with esophageal cancer[J].China Oncol,2008,18(5):354-357.DOI:10.3969/j.issn.1007-3639.2008.05.007. [13] 肖泽芬,林冬梅,吕宁,等.32例食管癌放射治疗后死亡的尸检分析[J].中华放射肿瘤学杂志,2001,10(2):80-82.DOI:10.3760/j.issn:1004-4221.2001.02.003. Xiao ZF,Lin DM,Lv N,et al. Autopsy finding in 32 cases treated by external beam radiotherapy alone for esophageal carcinoma[J].Chin J Radiat Oncol,2001,10(2):80-82.DOI:10.3760/j.issn:1004-4221.2001.02.003.
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