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A efficacy analysis of intensity-modulated radiotherapy or three-dimensional conformal radiotherapy for resected thoracic esophageal squamous cell carcinoma
Department of Radiation Oncology, Cancer Hospital (Institute), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China Corresponding author:XIAO Ze-fen, Email:xiaozefen@sina.com
Abstract Objective To analyze retrospectively the clinical therapeutic effect and toxicities of three-dimensional conformal radiotherapy (3DCRT) or intensity-modulated radiotherapy (IMRT) for resected stage Ⅱ/Ⅲ thoracic esophageal squamous cell carcinoma (TESCC). Methods A total of 251 patients with resected TESCC underwent 3DCRT or IMRT at the Cancer Hospital (Institute), Chinese Academy of Medical Sciences between 2004.1 to 2009.7 enrolled. Postoperative radiotherapy applied via 3DCRT (20 patients) or IMRT (231 patients) with a median total dose of 60 Gy. The Kaplan-Meier method was used to calculate the survival rates, and the log-rank test was used for univariate analysis. The Cox proportional model was used for multivariate analysis. Results The follow-up rate was 98.8%. 159 and 57 patients were followed to 3 and 5 years, respectively. The 1-, 3-and 5-year overall survival (OS) rates for all the patients were 90.8%, 56.1% and 45.8%, respectively. For the stage Ⅱa, Ⅱb, and Ⅲ stage patients, the 5-year OS rates were 65.0%, 53.8% and 38.4%, respectively (χ2=7.30,P=0.026). The 5-year OS rates were 64.9% and 40.4% for the patients with negative and positive lymph node metastasis (χ2=7.04,P=0.008). Univariate analysis showed that the significant prognostic factors include UICC 2002 stage, the degree of differentiation, lymphatic metastasis and vascular carcinomatous thrombus (χ2=7.30,7.04,8.34,9.40,P=0.026,0.008,0.004,0.002). Multivariate analysis revealed that the grade of differentiation, lymphatic metastasis and vascular carcinomatous thrombus were independent prognostic factors (χ2=6.86,5.27,4.24,P=0.009,0.022,0.040). Treatment failure occurred in 58patients because of systemic metastases, 14 cervical lymph node recurrence, 17 abdominal lymph node metastases, and 31 of intrathoracic recurrence. Five patients had grade 2 or worse late treatment-related anastomotic stenosis, and 8 patients died from late treatment-related gastrointestinal bleeding. Conclusions Postoperative prophylactic 3DCRT or IMRT of TESCC can provide a favorable local control rate and acceptable toxicity. Postoperative radiotherapy should be included into the standard treatment of Stage Ⅲ TESCC or TESCC with lymph node metastasis.
ZHANG Wen-cheng,WAGN Qi-feng,XIAO Ze-fen et al. A efficacy analysis of intensity-modulated radiotherapy or three-dimensional conformal radiotherapy for resected thoracic esophageal squamous cell carcinoma[J]. Chinese Journal of Radiation Oncology, 2012, 21(2): 136-139.
ZHANG Wen-cheng,WAGN Qi-feng,XIAO Ze-fen et al. A efficacy analysis of intensity-modulated radiotherapy or three-dimensional conformal radiotherapy for resected thoracic esophageal squamous cell carcinoma[J]. Chinese Journal of Radiation Oncology, 2012, 21(2): 136-139.
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2012, Vol. 21 
