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Objective:To evaluate the effect of definitive radiotherapy with different doses on overall survival (OS) and identify the prognostic factors of patients with non-metastatic esophageal squamous cell carcinoma (ESCC).Methods:Clinical data of 2 344 ESCC patients treated with definitive radiotherapy (RT) alone or chemoradiotherapy from 2002 to 2016 in 10 hospitals were collected and analyzed retrospectively. After the propensity score matching (PSM)(1 to 2 ratio), all patients were divided into the low-dose group (equivalent dose in 2 Gy fractions, EQD 2Gy<60 Gy; n=303) and high-dose group (EQD 2Gy≥60 Gy; n=606) based on the dose of radiation. Survival analysis was conducted by Kaplan- Meier method. Multivariate prognostic analysis was performed by Cox′s regression model. Results:The median follow-up time was 59.6 months. After the PSM, the 1-, 3- and 5-year overall survival (OS) rate was 66.5%, 34.7%, 27.2% in the low-dose group, 72.9%, 41.7% and 34.7% in the high-dose group, respectively ( P=0.018). The 1-, 3-and 5-year progression-free survival rate was 52.2%, 27.2%, 23.1% in the low-dose group, 58.3%, 38.1% and 33.9% in the high-dose group, respectively ( P=0.001). The outcomes of univariate analysis indicated that cervical/upper esophagus location, early (stage Ⅱ) AJCC clinical stage, node negative status, tumor length ≤5 cm, receiving intensity-modulated radiation therapy (IMRT), receiving concurrent chemotherapy and EQD 2Gy≥60 Gy were closely associated with better OS (all P<0.05). Multivariable analysis demonstrated that tumor location, regional lymph node metastasis, concurrent chemotherapy and EQD 2Gy were the independent prognostic factors for OS (all P<0.05). Conclusion:Three-dimensional conformal or IMRT with EQD 2Gy≥60 Gy yields favorable survival outcomes for patients with locally advanced ESCC.
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Objective@#To evaluate the prognostic factors of T1-2N0M0 esophageal squamous cell carcinoma (ESCC) treated with definitive radiotherapy.@*Methods@#The clinical data of 196 patients with T1-2N0M0 ESCC who were treated with definitive radiotherapy in 10 hospitals were retrospectively analyzed. All sites were members of Jing-Jin-Ji Esophageal and Esophagogastric Cancer Radiotherapy Oncology Group (3JECROG). Radiochemotherapy were applied to 78 patients, while the other 118 patients received radiotherapy only. 96 patients were treated with three-dimensional conformal radiotherapy (3DCRT) and 100 treated with intensity-modulated radiotherapy (IMRT). The median dose of plan target volume(PTV) and gross target volume(GTV) were both 60 Gy. The median follow-up time was 59.2 months. Log rank test and Cox regression analysis were used for univariat and multivariate analysis, respectively.@*Results@#The percentage of normal lung receiving at least 20 Gy (V20) was (18.65±7.20)%, with average dose of (10.81±42.05) Gy. The percentage of normal heart receiving at least 30 Gy (V30) was (14.21±12.28)%. The maximum dose of exposure in spinal cord was (39.65±8.13) Gy. The incidence of radiation pneumonia and radiation esophagitis were 14.80%(29/196) and 65.82%(129/196), respectively. The adverse events were mostly grade 1-2, without grade 4 toxicity. Median overall survival (OS) and progression-free survival (PFS) were 70.1 months and 62.3 months, respectively. The 1-, 3- and 5-year OS rates of all patients were 75.1%、57.4% and 53.2%, respectively. The 1-, 3- and 5-year PFS rates were 75.1%、57.4% and 53.2%, respectively. Multivariate analysis demonstrated that patients′age (HR=1.023, P=0.038) and tumor diameter (HR=1.243, P=0.028)were the independent prognostic factors for OS, while tumor volume were the independent prognostic factor for PFS.@*Conclusions@#Definitive radiotherapy is a promising therapeutic method in patients with T1-2N0M0 ESCC. Patients′ age, tumor diameter and tumor volume may impact patients′ prognosis.
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Objective To retrospectively analyze the effect of tumor length on the prognosis in stage Ⅱ/Ⅲ esophageal squamous cell carcinoma (ESCC) patients treated with definitive radiotherapy and to evaluate the role of tumor length in clinical stage for non-operative ESCC patients.Methods The data of 2 086 ESCC patients who were treated with definitive radiotherapy from 2002 to 2016 in 10 hospitals (3JECROG) were analyzed.The effect of tumor length on overall survival (OS) was analyzed and stratified analysis of tumor length was done in different stages of ESCC.Results The median OS and median progression-free survival (PFS) time of the whole group were 25.6 months and 18.2 months respectively.The Cox multivariate analysis showed that treatment moda,aga,alinical stage and tumor length were independent prognostic factors.The median,1-,3-,and 5-year OS were 28.9 months,77.3％,45.0％,and 36.3％ versus 21.9 months,69.9％,37.9％,and 28.1％ for patients with ≤ 5 cm and patients ＞ 5 cm respectively (P＜0.05).For stage Ⅱ patienta,abe median OS were 42.1 and 38.9 months respectively in ≤ 5 cm group and＞5 cm group (P=0.303).And for stage Ⅲ patienta,abe median OS were 23.9 and 19.3 months respectively in ≤5 cm group and＞5 cm group (P＜0.001).The median OS with N1was 24.1 and 18.4 montha,aespectively in ≤5 cm group and＞5 cm group (P＜0.001).Conclusions The tumor length was an independent prognostic factor for stage Ⅱ/Ⅲ patients treated definitive radiotherapy.The tumor length may be helpful in clinical staging of ESCa,aspecially for stage Ⅲ and N1.
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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 2 132 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 1 409 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 cm3 and 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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Objective To evaluate the survival and prognostic factors of esophageal cancer treated with definitive ( chemo ) radiotherapy by applying novel radiation techniques including three-dimensional conformal radiotherapy (3DCRT) or intensity-modulated radiotherapy (IMRT). Methods Clinical data of 2762 patients with non-operated esophageal squamous cell carcinoma who underwent definitive ( chemo ) radiotherapy from 2002 to 2016 in 10 hospitals were retrospectively analyzed.The prognostic factors were also identified and analyzed. Results The median follow-up time was 60. 8 months. The 1-, 2-, 3-and 5-year overall survival (OS) of all patients was 71. 4％,48. 9％,39. 3％,and 30. 9％,respectively.The 1-,2-,3-and 5-year progression-free survival (PFS) was 59.5％,41.5％,35.2％,and 30％,respectively.The median survival was 23 months.The median time to progression was 17. 2 months.Multivariate analysis demonstrated that age, primary tumor location, clinical stage, tumor target volume, EQD2 and treatment mode were the independent prognostic factors for OS.Primary tumor location,clinical stage,tumor target volume and EQD2 were the independent prognostic factors for PFS. Conclusions In this first large-scale multi-center retrospective analysis of definitive ( chemo) radiotherapy for esophageal squamous cell carcinoma in China, the 5-year OS of patients with esophageal squamous cell carcinoma is significantly improved by 3DCRT, IMRT combined with chemotherapy drugs. However, the findings remain to be validated by prospective clinical trials with high-level medical evidence.
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Objective To evaluate the clinical efficacy and analyze relevant prognostic factors of simultaneous integrated boost intensity-modulated radiation therapy ( SIB-IMRT ) for esophageal squamous cell carcinoma. Methods A total of 101 patients diagnosed with esophageal squamous cell carcinoma received SIB-IMRT from 2009 to 2015. The prescribed dose of PTV was 5040 cGy/28 times ( 180 cGy/time) and the dose for planning gross tumor volume (PGTV) was 6020 cGy/28 times (215 cGy/time) or 6160 cGy/28 times ( 220 cGy/time) simultaneously. The total treatment time was 5. 5 weeks ( once a day, 5 times a week).The adverse events, mode of treatment failure,l-,3-and 5-year local control (LC) and overall survival ( OS) rates were observed. Results The quantity of patients who completed the 1-,3-and 5-year follow-up was 101, 84 and 45, respectively. The 1-,3-and 5-year LC rates were 81. 6％,70. 4％ and 68. 4％, respectively. The 1-, 3-and 5-year OS rates were 72. 3％, 49. 4％ and 45. 2％, respectively. The median survival time was 36 months. Univariate and multivariate analyses showed that clinical staging ( stageⅠ/Ⅱ/Ⅲ) and tumor response ( complete remission/ partial remission/no remission ) were the prognostic factors of OS (P=0. 016,0. 000,0. 005,0. 000).There were no significant differences in the LC and OS between the two groups of 215 cGy and 220 cGy (P=0. 283,0. 951).The incidence rates of grade 1,2,3 acute pneumonitis were 10. 9％(11/101),2. 0％(2/101) and 2. 0％(2/101), respectively. The incidence rates of grade 1, 2, 3 acute esophagitis were 63. 4％( 64/101 ) , 10. 9％( 11/101 ) and 4. 0％( 4/101 ) , respectively. No acute esophageal perforation or hemorrhage occurred. Five patients experienced late pneumonitis ( two died) . One case developed late lemostenosis, two cases developed esophageal perforation and hemorrhage, and two patients experienced esophageal hemorrhage. The patients treated with a fractionated dose of 220 cGy had a higher incidence rate of acute pneumonitis and upper gastrointestinal adverse reactions than those receiving 215 cGy ( P= 0. 062, 0. 024 ) . The local failure and recurrence accounted for 62. 5％ of all treatment-related failures. Conclusions SIB-IMRT yields high long-term clinical efficacy and tolerable adverse events in the treatment of esophageal squamous cell carcinoma. Compared with the dose of 215 cGy, the fractionated dose of 220 cGy fails to improve LC and OS rates, whereas enhances the risk of adverse events. The clinical staging and short-term clinical efficacy are the prognostic factors of survival rate.
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Objective The recurrence rate is alarmingly high in patients with positive lymph node metastasis (pN+) esophageal squamous cell carcinoma (ESCC) after two-field surgery.This study aims to retrospectively evaluate the value of pN+ region in predicting postoperative recurrence in patients with pN+ thoracic ESCC after two-field radical esophagectomy.Methods A total of 329 patients with pN+ thoracic ESCC after two-field R0 esophagectomy were enrolled in this study.After surgery,pN+ region was located at the upper abdomen in 116 patients,mediastinum in 119 and upper abdomen plus mediastinum in 94,respectively.The enumeration data were analyzed by chi-square test.Logistic multivariate regression analysis was performed to evaluate the risk factors of postoperative recurrence.Cumulative recurrence rate was statistically analyzed by using Kaplan-Meier method,Log-rank test and Cox model multivariate analysis.Results The overall recurrence rate was 72.4％ (239/329).The overall locoregional recurrence (LR) rate was 58.1％(139/329) including 14.6％ in the neck,42.9％ in the mediastinum and 10.0％ in the upper abdomen.Multivariate logistic and Cox regression analyses demonstrated that pN + region was the only independent factor affecting the overall recurrence and LR rates (both P＜0.05).The overall recurrence and LR rates were 57.8％ and 44.0％ for patients with pN+ region in the upper abdomen,77.3％ and 62.3％ for those with pN+ region in the mediastinum and 85.1％ and 72.3％ for their counterparts with pN+ region in the upper abdomen and mediastinum,respectively.Additionally pN+ region was also the independent factor of the recurrence in the mediastinum or upper abdomen (both P＜0.05) rather than the neck (P＞0.05).The recurrence rates in the mediastimun and upper abomen were 27.6％ and 12.9％ for patients with pN+ region in upper abdomen,47.1％ and 4.2％ for those with pN+ region in the mediastinum,and 56.4％ and 13.8％ for patients with pN+ region in the upper-abdomen plus mediastinum,respectively.Conclusions LR is the main cause of failure in patients with pN + thoracic ESCC after two-field R0 surgery.pN + region can be utilized to predict the overall recurrence and LR rates,especially for patients with postoperative recurrence in the the mediastinum and upper abdomen.The findings in this investigation contribute to the design of the target volume of postoperative adjuvant radiotherapy.
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Objective To retrospectively analyze the factors of postoperative recurrence of stage pT1-3NoM0 esophageal squamous cell carcinoma.Methods A total of 488 patients who underwent two-field R0 esophagectomy,pathologically classified as stage pT1-3N0M0,without adjuvant radiotherapy and/or chemotherapy before or after surgery and postoperative survival time ≥ 3 months were enrolled in this study.Multivariate analysis was performed by using Cox model.Results At the end of follow-up,the overall recurrence rate was 36.9％(180/488);the local recurrence rate was 21.5％ (105/488),the distant metastasis rate was 6.8％ (33/488) and the local recurrence rate complicated with the distant metastasis rate was 8.6％ (42/488).Cox multivariate analysis demonstrated that tumor site and pT staging were the factors affecting the overall/local recurrence rate and distant metastasis.The recurrence rate in patients with the upper esophageal squamous cell carcinoma and stage pT3 was the highest,followed by those with the middle esophageal squamous cell carcinoma or stage pT2 and the lowest recurrence rate was observed in patients with the lower esophageal squamous cell carcinoma or stage pT1.Conclusions Tumor site and pT staging are the pivotal factors for postoperative recurrence of stage pT1-3 NoM0 esophageal squamous cell carcinoma after two-field R0 esophagectomy,which contributes to offer guidance to the selection of indications for postoperative adjuvant radiotherapy.
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Objective To analyze and compare the outcomes of esophageal carcinoma treated with simultaneous integrated boost intensity-modulated radiation therapy (SIB-IMRT) and late course boost intensity-modulated radiation therapy (LCB-IMRT).Methods We retrospectively analyzed 128 patients with esophageal squamous cell carcinoma who were treated with SIB-IMRT or LCB-IMRT at the fifth department of radiation oncology in our hospital,from January 2009 to August 2015.Propensity score matching analysis was used to balance the variables differences in the two groups.Survival,failure patterns and toxicities were observed and compared between the two groups.Results one hundred and eleven patients were finally included after propensity scores matching.The 1-,3-and 5-year local control rates and survival rates were 83.6％ vs.81.7％,70.8％ vs.46.3％ and 66.0％ vs.38.2％ in the whole group,respectively.The 1-,3-and 5-year local control rates of SIB-IMRT and LCB-IMRT group were 81.6％ vs.88.0％,72.3％ vs.67.6％ and68.5％ vs.60.8％,respectively (P＞0.05).The 1-,3-and 5-year survival rates of SIB-IMRT and LCB-IMRT group were 81.3％ vs.82.4％,51.7％ vs.36.7％ and 45.8％ vs.26.7％,respectively (P ＞ 0.05).There was no statistical difference between the two group in ≥ grade 3 toxicities (P ＞ 0.05).There were 40 (36.0％) patients result in treatment failure in all.The treatment failure rates in SIB-IMRT and LCB-IMRT group were 33.8％ (26/77) vs.41.2％ (14/34),respectively (P ＞ 0.05).The local failure accounted for 65.0％ (26/40) of all treatment-related failures.Conclusions The toxicities of esophageal squamous cell carcinoma treated with SIB-IMRT and LCB-IMRT have no significant differences and were well tolerated.There were no significant differences in local control rates and survival rates between the two groups.However,SIB-IMRT had better trend than LCB-IMRT.Given SIB-IMRT's convenient manipulation,it could be a better choice in the treatment of advanced esophageal carcinoma.
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Objective To assess the therapeutic efficacy and prognostic factors in elderly patients with stage Ⅲ non-small cell lung cancer (NSCLC) after three-dimensional conformal radiotherapy (3DCRT).Methods A retrospective analysis of 124 stage Ⅲ NSCLC patients aged 70 or over who had received treatment with 3DCRT was conducted retrospectively in this study.There were 99 male and 25 female patients,with a median age of 74 years(range:70-84).The median dose was 60 Gy(range 50-72 Gy).Eighty-three patients were treated with radiotherapy alone,27 with sequential and 14 with concurrent radiochemotherapy.Results The end date of follow-up was August 30,2013.After 3DCRT,the 1-,3-and 5-year overall survival (OS) were 61.1％,23.8％ and13.2 ％,respectively,and the median survival time was 18 months.Univariate analysis revealed that gender,obstructive pneumonia,dosage,method of therapy and immediate effect were related to OS(x2 =3.957,6.398,7.147,12.307 and 11.035,respectively;P=0.047,0.011,0.008,0.002 and 0.001,respectively).Multi-variable analysis indicated that age,gender,obstructive pneumonia,dosage and method of therapy were independent prognostic factors for OS.The OS time was longer inpatients who were female,aged over 75,with no obstructive pneumonia or dosage≥ 60 Gy.Compared with radiotherapy alone,sequential radiochemotherapy increased OS while concurrent radiochemotherapy decreased OS.Conclusions Sex,age,obstructive pneumonia and dosage affect the survival of elderly stage Ⅲ NSCLC patients treated with three-dimensional conformal radiotherapy.Concurrent radiochemotherapy should be considered with caution
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Objective@#To investigate the postoperative prognosis and the related factors of patients with stage pT2N0-1M0 of thoracic esophageal carcinoma(EC).@*Methods@#From 2008 to 2011, clinical data of 275 cases with stage pT2N0-1M0 of thoracic EC treated by esophagectomy were enrolled. These cases includ 180 male and 95 female. Among them, 32 cases were upper thoracic EC, 186 cases were middle thoracic EC and 57 cases were lower thoracic EC. Alternatively, 205 cases were stage pN0, 70 cases were stage pN1. 155 cases received esophagectomy alone and 120 cases received esophagectomy and postoperative adjuvant therapy.@*Results@#The end of follow-up time was on September 30th, 2014. The 1-, 3-, 5-year overall survival (OS) rates were 91.6%, 70.2% and 63.7%, respectively. The 1- 3-, 5-year progression-free survival (PFS) rates were 83.9%, 64.0% and 60.0%, respectively. The result of univariate analysis showed that the depth of tumor invasion, pathological type, pN stage and number of metastatic lymph nodes were significantly associated with OS (all of P<0.05). Moreover, the gender, the depth of tumor invasion, pathological type, pN stage and number of metastatic lymph nodes were significantly associated with PFS (all of P<0.05). Cox multivariate analysis showed that the location of primary tumor and pN stage were the independent factors of OS (both P<0.05). The gender, pN stage and postoperative adjuvant therapy were the independent factors of PFS (all of P<0.05).@*Conclusion@#Among the patients with pT2N0~1M0 stage of thoracic EC, patients with upper thoracic EC or pN1 stage have poorer postoperative prognosis compared with others, and postoperative adjuvant treatment is recommended for these patients.
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Objective@#To evaluate the patterns of recurrence and their value on target delineation for postoperative radiotherapy (RT) in patients with stage Ⅲ thoracic esophageal squamous cell carcinoma (ESCC) after esophagectomy.@*Methods@#395 patients (302 male and 93 female) of stage Ⅲ thoracic ESCC after radical resection were enrolled in this study. Among them, 375 patients were treated with two-field and other 20 with three-field esopahgectomy. 97 patients were treated with surgery alone, 212 with adjuvant postoperative chemotherapy (CT), 56 with radiotherapy (RT) and 30 with CT plus RT. Diagnosis of recurrence was primarily based on CT images, some of which were biopsy confirmed. The location and patterns of tumor recurrence were analyzed.@*Results@#The overall failure rates was 75.7% (299/395). Locoregional recurrence (LR) was found in 48.4% of the patients, distant metastasis (DM) in 16.2%, and LR plus DM in 4.3%. There were 208 patients occurred with LR, 26.9% (56) recurred in supraclavicular/neck (51 in supraclavicular), 69.7% (145) in mediastinum (88.7% in upper-mediastinum), and 19.7% (41) in upper abdomen (38 in para-aortic lymph node). Chi-square test and logistic multivariate regression analysis showed that TNM stage and adjuvant therapy were significantly associated with LR (P<0.05). Postoperative RT reduced LR (mainly LR in mediastinum), but postoperative CT did not decrease LR.@*Conclusions@#The recurrence rate is very high in stage Ⅲ thoracic ESCC patients, LR is the main pattern of failure. TNM stage is one of the most important factors for LR. Postoperative radiotherapy can reduce LR but postoperative chemotherapy does not decrease LR. Upper-mediastinum is the most common site of recurrence, followed by supraclavicular and para-aortic regions; these areas should be considered as the key target of postoperative radiotherapy.
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Stage Ⅲ A non-small cell lung cancer (NSCLC) has high heterogeneity and there are some controversies over the treatment of this disease,especially for patients with stage ⅢA-N2 NSCLC.This article investigates whether preoperative or postoperative radiotherapy can improve the survival of patients with stage ⅢA-N2 NSCLC and evaluates the effect of surgical treatment.
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Objective To retrospectively analyze the value of postoperative adjuvant therapy in the treatment of stageⅢthoracic esophageal squamous cell carcinoma ( ESCC) . Methods From 2008 to 2011, a total of 395 patients with stageⅢthoracic ESCC undergoing radical resection were enrolled as subjects. In those patients.97 received surgery alone (S).212 postoperative adjuvant chemotherapy (POCT),and 86 postoperative radiotherapy (PORT).Comparison of categorical data was made by chi?square test. The survival rates were calculated by the Kaplan?Meier method. The log?rank test was used for between?group comparison and univariate analysis. Results All patients were followed up for at least 3 years.125 cases were followed up for at least 5 years. The 5?year overall survival ( OS) rates in patients treated with S,POCT and PORT were 17. 1%,29. 2% and 36. 4%,respectively (P=0. 000).POCT and PORT could mainly increased OS in patients of males.upper?and middle?segment,severe ahhesion at surgery.well?or middle?differentiation,stageⅢa andⅢb(P=0. 000?0. 049);whenever ages.tumor lesion,two?/three field esophagectomy.and the number of removal lymph nodes. PORT could improved OS also (P=0. 001?0. 047).POCT could also improve OS in patients of ages≤60, tumor lesion<6 cm and removal lymph nodes<10 ( P=0. 002?0. 049 ) . The 5?year progression?free survival (PFS) were 19. 0% with S,28. 8% with POCT,36. 4% with PORT,respectively (P=0. 012).PORT could improve PFS (P=0. 012);especially for patients of males,ages ≤60,upper?and middle segment ESCC,tumor lesion ≥6 cm,severe ahhesion at surgery,removal lymph node<10 and ≥10,well or middle differentiation,stageⅢa andⅢb(P=0. 001?0. 042).But POCT could not increased PFS (P=0. 119) . Conclusions In the treatment of patients with stage Ⅲ thoracic ESCC undergoing radical resection,both POCT and PORT can improve the OS rate, particularly in patients with stage Ⅲa or Ⅲb middle and upper thoracic ESCC, severe adhesion formation during surgery. and moderately or well differentiated squamous cell carcinoma. The DFS rate is improved in patients treated with PORT,but not in those treated with POCT.
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Objective To investigate the therapeutic effects,adverse effects,and patterns of failure of elective irradiation of lymphatic drainage area (extended-field) and involved-field irradiation in three-dimensional radiotherapy (3DRT) in patients with esophageal cancer via a Meta-analysis.Methods The databases Wanfang Data,CNKI,VIP,CBM,PubMed,Embase,and Cochrane Library were searched to collect the controlled clinical trials on extended-field irradiation and involved-field irradiation in 3DRT in patients with esophageal cancer.Stata 11.0 was used for data analysis.The odds ratio (OR) with 95％ confidence interval was used to describe the differences between two groups.Results According to the inclusion and exclusion criteria,a total of 12 controlled clinical trials involving 1 095 patients with esophageal cancer were included in this meta-analysis.The results of the meta-analysis showed that compared with the involved-field irradiation group,the extended-field irradiation group had a significantly reduced rate of out-field failure in patients with esophageal cancer who received 3DRT (OR=3.727,P=0.007),but showed significantly higher rates of grade ≥ 3 acute radiation pneumonitis and radiation esophagitis (acute radiation pneumonitis:OR =0.348,P =0.001;radiation esophagitis:OR =0.385,P =0.000).The two groups had similar 1-,2-,and 3-year local control rate and overall survival rate (local control rate:OR=0.966/0.946/0.732,P=0.837/0.781/0.098;overall survival rate:OR=0.952/1.149/0.768,P=0.756/0.422/0.120),as well as a similar distant metastasis rate (OR=0.986,P=0.937).Conclusions Compared with involved-field irradiation,extended-field irradiation can reduce the rate of out-field failure in patients with esophageal cancer who receive 3DRT.However,it does not have significant advantages in local control rate and overall survival rate and has an increased incidence rate of adverse effects.
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Objective To evaluate the efficacy of three-dimensional conformal radiotherapy (3DCRT) and prognostic factors for stage Ⅲ non-small cell lung cancer (NSCLC).Methods From 2000 to 2010,474 patients with stage Ⅲ NSCLC undergoing 3DCRT were enrolled as subjects.Those patients,consisting of 382 males and 92 females,had a median age of 63 years.In those patients,211 had stage ⅢA NSCLC and 263 had stage ⅢB NSCLC;165 were treated with radiotherapy alone and 309 with chemoradiotherapy;55 were treated with conventional radiotherapy plus 3DCRT,340 with 3DCRT,and 79 with intensity-modulated radiotherapy;the median equivalent dose was 60 Gy (44-77 Gy).The Kaplan-Meier method,log-rank test,and Cox model were used for survival rate calculation,univariate analysis,and multivariate analysis,respectively.Results The follow-up rate was 96.6％.In all patients,the 1-,3-,and 5-year overall survival rates were 63.0％,24.9％,and 17.8％,respectively;the median survival time was 18 months.The univariate analysis showed that sex,age,immediate response,radiotherapy method,fractionation scheme,chemotherapy,and radiation pneumonitis (RP) were prognostic factors (P=0.004,0.001,0.000,0.007,0.004,0.009,0.049).The multivariate analysis showed that sex,age,immediate response,radiotherapy method,and RP were independent prognostic factors (P=0.006,0.000,0.000,0.003,0.048).Patients with radiation doses of 60-66 Gy had the best prognosis of all.Conclusions In patients with stage Ⅲ NSCLC undergoing 3DCRT,female patients,patients at a young age,patients with satisfactory immediate response,patients treated with full-course 3DCRT,and patients with grade 0-1 RP have better prognosis than others.3DCRT combined with chemotherapy improves survival in patients.A radiation dose of 60-66 Gy is recommended.
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A considerable proportion of patients with non small cell lung cancer (NSCLC) require postoperative adjuvant therapy,postoperative radiotherapy is an important part of the treatment,this article review the role and value of postoperative radiotherapy for NSCLC patients in recent years.
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<p><b>OBJECTIVE</b>To evaluate the patterns of recurrence and the related factors in patients with pT3N0M0 thoracic esophageal squamous cell carcinoma (ESCC) after two-field esophagectomy.</p><p><b>METHODS</b>From Jan 2008 to Dec 2009, 208 patients with stage pT3N0M0(2002, UICC) thoracic ESCC were treated with two-field esophagectomy in our hospital. There were 138 males and 70 females, and the median age was 60 years old (range 33-78). There were 33 patients in the upper-, 134 in the middle-, and 41 in the lower-thoracic esophagus, with a median length of lesion of 5 cm. There were 32 patients with no-, 78 with mild- and 98 patients with severe adhesions at surgery. The median number of dissected lymph nodes was 9 (range 1-27). 98 patients were treated with surgery alone and 110 with postoperative adjuvant chemotherapy. The statistical analysis was conducted using SPSS 13.0 software.</p><p><b>RESULTS</b>The follow-up was ended on July 2013. In the total group of 208 patients, the total recurrence rate was 41.8% (87/208). Among them, 52 patients had locoregional recurrence (LR), 15 had distant metastasis (DM) and 20 patients had both local recurrence and distant metastasis. 40.2% (35/87) of all recurrences were found within one year after operation, 67.8% (59/87) within 2 years, 86.2% (75/87) within 3 years, and 100% (87/87) within 4 years. The 1-, 3-, and 5-year progression-free survival (PFS) rate was 83.0%, 62.8% and 56.3%, respectively. The overall locoregional recurrence rate was 34.6% (72/208), among them, 9 cases had recurrence in the cervix (all were supraclavicular lymph node metastasis), 66 cases in the mediastinum and 4 cases had para-aortic lymph node metastasis. 83.3% (60/72) of the locoregional recurrence was located in the carinal region or upper area. The 1-, 3-, 5-year locoregional recurrence rate was 15.6%, 32.2%, and 36.8%, respectively, and the median time of recurrence was 15.5 months. The overall distant metastasis (DM) rate was 16.8% (35/208). The 1-, 3-, and 5-year DM rate was 4.4%, 15.3%, and 20.1%, respectively, and the median time of DM was 24 months. The most common site of DM was the lung and bone. The univariate analysis showed that age and tumor site were associated with PFS, tumor site and small lymph node in the mediastinum (diamter <1 cm) before surgery were related with LR (P<0.05 for all), and tumor site, histological differentiation and LR were related with distant metastasis after surgery (P<0.05). Multivariate analysis showed that the tumor site was an independent prognostic factor affecting the progression-free survival and locoregional recurrence (P<0.05), and histological differentiation and LR were independent factors associated with distant metastasis (P<0.05 for all).</p><p><b>CONCLUSIONS</b>The recurrence rate is very high in patients with pT3N0M0 thoracic ESCC after surgery, and most of them occur within 3 years after operation. Locoregional recurrence occurs more frequently and shortly than distant metastasis, and most of LR is located in the carinal region or upper-mediastinum. LR rate in upper-thoracic ESCC is very high, therefore, postoperative radiotherapy (PORT) is strongly suggested. LR rate in middle thoracic ESCC is also rather high and PORT is suggested. LR occur much less in the lower-thoracic ESCC, thus, PORT is not suggested routinely. Patients with poorly differentiated ESCC and LR have a high rate of distant metastasis.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Carcinoma, Squamous Cell , Drug Therapy , Pathology , General Surgery , Chemotherapy, Adjuvant , Disease-Free Survival , Esophageal Neoplasms , Drug Therapy , Pathology , General Surgery , Esophagectomy , Methods , Lymph Node Excision , Lymph Nodes , Lymphatic Metastasis , Mediastinum , Multivariate Analysis , Neck , Neoplasm Recurrence, Local , Pathology , Neoplasm Staging , Postoperative PeriodABSTRACT
Objective To evaluate the efficacy of salvage radiotherapy for supraclavicular lymph node metastasis ( SLNM) after initial treatment in patients with esophageal cancer. Methods A total of 117 patients with SLNM after radical resection for esophageal cancer were enrolled as subjects from 2006 to 2012. All patients received three?dimensional radiotherapy with 1. 8?2. 0 Gy per cycle, 5 cycles a week. The survival rates were calculated using the Kaplan?Meier method and analyzed using the log?rank test. The Cox model was used for multivariate analysis. Results The follow?up rate was 100%. In all the patients, the 1?and 3?year overall survival (OS) rates were 38. 5% and 14. 1%, respectively. The 1?and 3?year OS rates were significantly higher in patients treated with salvage radiotherapy or radiochemotherapy ( n=100) than in patients without any salvage treatment (n=17)(42% vs. 18%,P=0. 008;17% vs. 0%, P=0. 008). The patients treated with radiochemotherapy ( n=32) had significantly higher 1?and 3?year OS rates than those treated with radiotherapy alone (n=68)(59% vs. 34%, 36% vs. 11%, P=0. 002) or without any salvage treatment (n=17)(59% vs. 18%, 36% vs. 0%, P=0. 002). Patients without visceral metastasis (n=80) had significantly higher 1?and 3?year OS rates than those with visceral metastasis ( n=37) ( 44% vs. 27%, P=0. 002;22% vs. 0%,P=0. 002) . Patients with supraclavicular doses of ≥60 Gy in salvage radiotherapy ( n=75) had significantly higher 1?and 3?year OS rates than those with supraclavicular doses of<60 Gy in salvage radiotherapy ( n=25) ( 75% vs. 25%,P=0. 000;24% vs. 8%,P=0. 000) . The multivariate analysis using the Cox model showed that supraclavicular doses of ≥60 Gy, mediastinal metastasis, visceral metastasis, and salvage treatment method were independent factors for survival ( P=0. 001,0. 015,0. 009, 0. 025) . Conclusions Salvage radiotherapy can improve the survival of patients with SLNM in esophageal cancer. Salvage radiotherapy or radiochemotherapy is highly recommended for patients with SLNM alone. A radiation dose of ≥60 Gy in salvage radiotherapy improves survival in patients.
ABSTRACT
Objective To analyze the efficacy of salvage therapy for postoperative recurrence or metastasis in patients with stage T3 N0 M0 thoracic esophageal squamous cell carcinoma ( ESCC ) and its influencing factors. Methods A retrospective analysis was performed in 108 patients with postoperative recurrence or metastasis in stage T3 N0 M0 thoracic ESCC who were admitted to our hospital from 2008 to 2009. In those patients, 59 had locoregional recurrence ( LR) , 26 distant metastasis ( DM) , and 23 both LR and DM. After recurrence, 53 patients received supportive therapy, 32 salvage radiotherapy, 9 chemotherapy, and 14 chemoradiotherapy. The overall survival ( OS) rates were calculated using the Kaplan?Meier method and analyzed using the log?rank test. The univariate and multivariate prognostic analyses were performed using the log?rank test and the Cox regression model, respectively. Results The follow?up rate was 100%. In all patients, the 1?, 3?, and 4?year OS rates were 29?9%, 16?5%, and 14?4%, respectively;the median OS time was 6 months. The univariate analysis showed that recurrence pattern and salvage therapy were associated with OS after recurrence ( P=0?017;P=0?000) . The multivariate analysis showed that salvage therapy was the only independent factor for OS after recurrence ( P=0?000) . Compared with supportive therapy, the risk of death after chemotherapy, radiotherapy, or chemoradiotherapy was reduced by 76?7%, 76?7%, and 86?1%, respectively. Conclusions The treatment outcomes are poor in patients with postoperative recurrence of stage T3 N0 M0 thoracic ESCC. Salvage therapy can substantially improve OS after recurrence.