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Analysis of the 10-year survival results of patients with esophageal squamous cell carcinoma achieving clinical complete remission after radical radiotherapy
Li Runxiao, Shen Wenbin, Cao Yankun, Song Chunyang
Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China
AbstractObjective To investigate the long-term prognosis and failure mode of patients with esophageal squamous cell carcinoma who achieved clinical complete remission (cCR) after receiving radical radio (chemo) therapy. Methods Clinical data of 183 patients with esophageal squamous cell carcinoma eligible for inclusion criteria who received treatment in our hospital from January 2009 to December 2012 were retrospectively analyzed. The factors that affected the long-term prognosis of patients were identified, and the failure mode of cCR patients and the prognosis after failure were analyzed. SPSS 19.0statistical software was used for data analysis. Results As of the follow-up date, the 1-, 3-, 5-, and 10-year overall survival (OS) rates and disease-free survival (DFS) rates of the entire group were 83.1%,53.4%,36.2%,12.8% and 68.9%,45.9%, 30.5%, 12.0%,respectively. The median OS and DFS were 41.3 months and 33.4 months. The results of multivariate analysis showed that cT staging, cN staging and prescribed dose were the independent factors affecting the OS (P=0.001, <0.001, 0.003);hoarseness, lesion length, cT staging, cN staging and prescribed dose were the independent factors that affected the DFS (P=0.002, 0.033, 0.009,<0.001, 0.003). In the whole group,72 cases (39.3%) had local regional recurrence,58 cases (31.7%) had distant metastasis, and 26 cases (14.2%) had local regional recurrence with distant metastasis. Among 104 patients after treatment failure, the prognosis of patients receiving salvage treatment was significantly better than that of their counterparts receiving maintenance treatment (χ2=39.153, P<0.001). Conclusions The long-term prognosis of patients with esophageal squamous cell carcinoma who achieved cCR after receiving radical radio (chemo) therapy is still unsatisfactory. Clinically, it is necessary to strengthen the clinical observation and follow-up of these patients. The main treatment failure mode of cCR patients is local regional recurrence. Active salvage treatment can significantly improve clinical prognosis of these patients.
Li Runxiao,Shen Wenbin,Cao Yankun et al. Analysis of the 10-year survival results of patients with esophageal squamous cell carcinoma achieving clinical complete remission after radical radiotherapy[J]. Chinese Journal of Radiation Oncology, 2022, 31(6): 525-531.
Li Runxiao,Shen Wenbin,Cao Yankun et al. Analysis of the 10-year survival results of patients with esophageal squamous cell carcinoma achieving clinical complete remission after radical radiotherapy[J]. Chinese Journal of Radiation Oncology, 2022, 31(6): 525-531.
[1] Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018:GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2018, 68(6):394-424. DOI:10.3322/caac.21492. [2] Watanabe M, Otake R, Kozuki R, et al. Recent progress in multidisciplinary treatment for patients with esophageal cancer[J]. Surg Today, 2020, 50(1):12-20. DOI:10.1007/s00595-019-01878-7. [3] van Hagen P, Hulshof MC, van Lanschot JJ, et al. Preoperative chemoradiotherapy for esophageal or junctional cancer[J]. N Engl J Med, 2012, 366(22):2074-2084. DOI:10.1056/NEJMoa1112088. [4] Harada K, Rogers JE, Iwatsuki M, et al. Recent advances in treating oesophageal cancer[J]. F1000Res, 2020, 9DOI:10.12688/f1000research.22926.1. [5] Gao LR, Wang X, Han W, et al. A multicenter prospective phase Ⅲ clinical randomized study of simultaneous integrated boost intensity-modulated radiotherapy with or without concurrent chemotherapy in patients with esophageal cancer:3JECROG p-02 study protocol[J]. BMC Cancer, 2020, 20(1):901. DOI:10.1186/s12885-020-07387-y. [6] Zhao Z, Zhang Y, Wang X, et al. Clinical response to chemoradiotherapy in esophageal carcinoma is associated with survival and benefit of consolidation chemotherapy[J]. Cancer Med, 2020, 9(16):5881-5888. DOI:10.1002/cam4.3273. [7] Mori K, SugawaraK, Aikou S, et al. Esophageal cancer patients' survival after complete response to definitive chemoradiotherapy:a retrospective analysis[J]. Esophagus,2021, 18(3):629-637. DOI:10.1007/s10388-021-00817-1. [8] Chen M, Liu P, Chen Y, et al. Primary tumor regression patterns in esophageal squamous cell cancer treated with definitive chemoradiotherapy and implications for surveillance schemes[J]. Cancer Manag Res, 2019, 11:3361-3369. DOI:10.2147/CMAR. S198524. [9] Li B, Hu H, Zhang Y, et al. Three-field versus two-field lymphadenectomy in transthoracic oesophagectomy for oesophageal squamous cell carcinoma:short-term outcomes of a randomized clinical trial[J]. Br J Surg, 2020, 107(6):647-654. DOI:10.1002/bjs.11497. [10] Yang H, Liu H, Chen Y, et al. Neoadjuvant chemoradiotherapy followed by surgery versus surgery alone for locally advanced squamous cell carcinoma of the esophagus (NEOCRTEC5010):a phase Ⅲ multicenter, randomized, open-label clinical trial[J]. J Clin Oncol, 2018, 36(27):2796-2803. DOI:10.1200/JCO.2018.79.1483. [11] Kato K, Shah MA, Enzinger P, et al. KEYNOTE-590:phase Ⅲ study of first-line chemotherapy with or without pembrolizumab for advanced esophageal cancer[J]. Future Oncol, 2019, 15(10):1057-1066. DOI:10.2217/fon-2018-0609. [12] Li C, Tan L, Liu X, et al. Concurrent chemoradiotherapy versus radiotherapy alone for patients with locally advanced esophageal squamous cell carcinoma in the era of intensity modulated radiotherapy:a propensity score-matched analysis[J]. Thorac Cancer, 2021, 12(12):1831-1840. DOI:10.1111/1759-7714.13971. [13] Chen Y, Ye J, Zhu Z, et al. Comparing paclitaxel plus fluorouracil versus cisplatin plus fluorouracil in chemoradiotherapy for locally advanced esophageal squamous cell cancer:A randomized, multicenter, phase Ⅲ clinical trial[J]. J Clin Oncol, 2019, 37(20):1695-1703. DOI:10.1200/JCO.18.02122. [14] Heneghan HM, Donohoe C, Elliot J, et al. Can CT-PET and endoscopic assessment post-neoadjuvant chemoradiotherapy predict residual disease in esophageal cancer?[J]. Ann Surg, 2016, 264(5):831-838. DOI:10.1097/SLA.0000000000001902. [15] Fitzgerald RC. Organ-preserving approaches in oesophageal cancer[J]. Lancet Oncol, 2018, 19(7):858-859. DOI:10.1016/S1470-2045(18)30291-2. [16] Ajani JA, Bhutani MS, Swisher SG. Oesophageal preservation in locally advanced oesophageal cancer[J]. Lancet Oncol, 2018, 19(9):e430. DOI:10.1016/S1470-2045(18)30617-X. [17] Liw PX, Wen YW, Tsai CY, et al. Pretreatment clinical stage predicts locoregional recurrence in patients with esophageal cancer who achieved a complete clinical response to chemoradiotherapy[J]. J Thorac Cardiovasc Surg, 2018, 155(5):2233-2242.e2. DOI:10.1016/j.jtcvs.2017.12.082. [18] Ishihara R, Yamamoto S, Ⅱshi H, et al. Factors predictive of tumor recurrence and survival after initial complete response of esophageal squamous cell carcinoma to definitive chemoradiotherapy[J]. Int J Radiat Oncol Biol Phys, 2010, 76(1):123-129. DOI:10.1016/j.ijrobp.2009.01.038. [19] Adenis A, Tresch E, Dewas S, et al. Clinical complete responders to definite chemoradiation or radiation therapy for oesophageal cancer:predictors of outcome[J]. BMC Cancer, 2013, 13:413. DOI:10.1186/1471-2407-13-413. [20] Cooper JS, Guo MD, 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. DOI:10.1001/jama.281.17.1623. [21] Luo HS, Huang HC, Lin LX. Effect of modern high-dose versus standard-dose radiation in definitive concurrent chemo-radiotherapy on outcome of esophageal squamous cell cancer:a meta-analysis[J]. Radiat Oncol, 2019, 14(1):178. DOI:10.1186/s13014-019-1386-x. [22] Yen YC, Chang JH, Lin WC, et al. Effectiveness of esophagectomy in patients with thoracic esophageal squamous cell carcinomareceiving definitive radiotherapy or concurrent chemoradiotherapy through intensity-modulated radiation therapy techniques[J]. Cancer, 2017, 123(11):2043-2053. DOI:10.1002/cncr.30565. [23] Suh YG, Lee IJ, Koom WS, et al. High-dose versus standard-dose radiotherapy with concurrent chemotherapy in stages Ⅱ-Ⅲ esophageal cancer[J]. Jpn J Clin Oncol, 2014, 44(6):534-540. DOI:10.1093/jjco/hyu047. [24] Zhang P, Xi M, Zhao L, et al. Clinical efficacy and failure pattern in patients with cervical esophageal cancer treated with definitive chemoradiotherapy[J]. Radiother Oncol, 2015, 116(2):257-261. DOI:10.1016/j.radonc.2015.07.011. [25] Zhao L, Zhou Y, Mu Y, et al. Patterns of failure and clinical outcomes of definitive radiotherapy for cervical esophageal cancer[J]. Oncotarget, 2017, 8(13):21852-21860. DOI:10.18632/oncotarget.15665. [26] Du XX, Yu R, Wang ZF, et al. Outcomes and prognostic factors for patients with cervical esophageal cancer undergoing definitive radiotherapy or chemoradiotherapy[J]. Bosn J Basic Med Sci, 2019, 19(2):186-194. DOI:10.17305/bjbms.2019.3873.