ABSTRACT
Objective: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 19.0 statistical 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.
ABSTRACT
Objective:To analyze the clinical prognosis of patients with cervical and upper thoracic esophageal squamous cell carcinoma treated with radical intensity-modulated radiotherapy (IMRT) with or without chemotherapy, and to explore the significance of elective lymph node irradiation (ENI).Methods:A retrospective analysis was performed on 309 patients with cervical and upper thoracic esophageal squamous cell carcinoma who underwent IMRT with or without chemotherapy in the Department of Radiology, the Fourth Hospital of Hebei Medical University. The prognostic factors were analyzed and patients receiving different irradiation methods were assigned into different group. The curative effect, toxicity and side effects were analyzed among different groups.Results:The 1-, 3-and 5-year overall survival (OS) and progression-free survival (PFS) were 76.7%, 37.4%, 19.3% and 59.7%, 27.4% and 14.4%, respectively, with median values of 26.8 and 15.5 months. Multivariate analysis showed that gender, cTNM staging and chemotherapy were the prognostic factors affecting the OS ( P=0.003, P<0.001, P=0.022), and gender, cTNM stage and radiation mode were the prognostic factors affecting the PFS ( P=0.016, P<0.001, P=0.008). After propensity score matching (PSM), the 1-, 3-, and 5-year OS and PFS were 77.2%, 39.3%, 20.0%, and 62.0%, 29.3%, and 15.4%, respectively, with median values of 27.1 and 18.2 months. Multivariate analysis showed that gender, cTNM staging and chemotherapy were the prognostic factors affecting the OS ( P=0.026, P<0.001, P=0.017); cTNM staging and irradiation mode were the prognostic factors affecting the PFS ( P<0.001, P=0.008). A subgroup analysis of chemotherapy showed that patients receiving 3-4 cycles of chemotherapy were preferred. The side effects of the patients were mainly grade 0 to 2, which could be tolerated. Conclusions:IMRT combined with or without chemotherapy is an efficacious treatment for patients with cervical and upper thoracic esophageal squamous cell carcinoma; ENI can improve the PFS of patients.
ABSTRACT
Objective To evaluate the effect of locoregional risk factors of esophageal cancer on the recurrence of gross tumor volume (GTV) in patients with No esophageal squamous cell carcinoma after radical intensity-modulated radiotherapy (IMRT) and to evaluate its effect on the 10-year survival of patients.Methods Clinical data of 374 patients with clinical N0 esophageal squamous cell carcinoma who underwent radical IMRT in the Fourth Hospital of Hebei Medical University from 2005 to 2010 were retrospectively analyzed.Involved-field irradiation was performed in 284 patients and selective lymph node irradiation was given in 90 patients.Concurrent radiochemotherapy was conducted in 69l patients and sequential radiochemotherapy was performed in 38 patients.The survival analysis was carried out by Kaplan-Meier method.The prognosis analysis was performed by multivariate Cox's regression model.Results A total of 143 patients (38.2％) had recurrence in GTV.The maximum transverse diameter (GTV-D),GTV volume (GTV-V) and GTV volume/length (GTV-V/L) of GTV patients were significantly longer than those without recurrence in GTV (P=0.008,0.043,0.001).ROC curve analysis showed that the optimal diagnostic thresholds for GTV-D,GTV-L,GTV-V and GTV-V/L for GTV recurrence were 3.5 cm,5.5 cm,24.0 cm3 and 4.6 cm2,respectively (P=0.000,0.003,0.000 and 0.000),and the ratio of recurrence within GTV in the patient group was significantly greater than that in the smaller group (P=0.000,0.002,0.001 and 0.000).GTV-L and GTV-V/L were the independent risk factors of recurrence in GTV (P=0.021 and 0.009).The 3-,5-and 10-year survival rates of all patients in the whole group were 42.9％,23.2％ and 7.9％,respectively.Multivariate analysis demonstrated that age,T stage,concurrent radiochemotherapy,GTV-D and GTV-V/L were the independent risk factors of survival (P=0.027,0.000,0.018,0.009 and 0.034).The main cause of death in patients with a survival time of more than 5 years was still associated with cancer.Conclusions The locoregional risk factors of esophageal cancer exert significant effect on the recurrence of GTV in patients with No esophageal squamous cell carcinoma undergoing radical radiochemotherapy,which can be utilized as the predicting markers.Both GTV-D and GTV-V/L are significantly correlated the 10-year survival of patients.
ABSTRACT
Objective To evaluate the effect of different irradiation methods on the long-term prognosis of patients with clinical T2-3N0M0 esophageal squamous cell carcinoma,aiming to select the optimal treatment for these patients.Methods A total of 268 eligible patients admitted to our hospital from January 2007 to December 2012 were enrolled in this study.All patients were divided into the involved-field irradiation (IFI) and elective node irradiation (ENI) groups.The composition ratio,prognostic factors and adverse events were analyzed between two groups.Results The median overall survival (OS) time was 35.5 months (95％CI:30.12-40.88) and the median disease-free survival (DFS) time was 23.5 months (95％CI:19.00-28.00).According to the multivariate analysis results,all patients were assigned into two groups at a ratio of 1 vs.1(n=86 in each group).Multivariate analysis after propensity score matching (PSM) demonstrated that irradiation method was the independent factor of OS (P=0.038),and T stage and radiotherapy were the independent factors affecting DFS (P=0.002,0.032).The incidence of ≥ grade Ⅱ adverse events did not significantly differ between two groups (P=0.819,0.756).However,patients with combined chemotherapy experienced more adverse events.Conclusion ENI can prolong the OS and DFS of patients with clinical T2-3NoMo esophageal squamous cell carcinoma,and does not increase the incidence of severe adverse events.
ABSTRACT
Objective@#To evaluate the effect of locoregional risk factors of esophageal cancer on the recurrence of gross tumor volume (GTV) in patients with N0 esophageal squamous cell carcinoma after radical intensity-modulated radiotherapy (IMRT) and to evaluate its effect on the 10-year survival of patients.@*Methods@#Clinical data of 374 patients with clinical N0 esophageal squamous cell carcinoma who underwent radical IMRT in the Fourth Hospital of Hebei Medical University from 2005 to 2010 were retrospectively analyzed. Involved-field irradiation was performed in 284 patients and selective lymph node irradiation was given in 90 patients. Concurrent radiochemotherapy was conducted in 69l patients and sequential radiochemotherapy was performed in 38 patients. The survival analysis was carried out by Kaplan-Meier method. The prognosis analysis was performed by multivariate Cox’s regression model.@*Results@#A total of 143 patients (38.2%) had recurrence in GTV. The maximum transverse diameter (GTV-D), GTV volume (GTV-V) and GTV volume/length (GTV-V/L) of GTV patients were significantly longer than those without recurrence in GTV (P=0.008, 0.043, 0.001). ROC curve analysis showed that the optimal diagnostic thresholds for GTV-D, GTV-L, GTV-V and GTV-V/L for GTV recurrence were 3.5 cm, 5.5 cm, 24.0 cm3 and 4.6 cm2, respectively (P=0.000, 0.003, 0.000 and 0.000), and the ratio of recurrence within GTV in the patient group was significantly greater than that in the smaller group (P=0.000, 0.002, 0.001 and 0.000). GTV-L and GTV-V/L were the independent risk factors of recurrence in GTV (P=0.021 and 0.009). The 3-, 5-and 10-year survival rates of all patients in the whole group were 42.9%, 23.2% and 7.9%, respectively. Multivariate analysis demonstrated that age, T stage, concurrent radiochemotherapy, GTV-D and GTV-V/L were the independent risk factors of survival (P=0.027, 0.000, 0.018, 0.009 and 0.034). The main cause of death in patients with a survival time of more than 5 years was still associated with cancer.@*Conclusions@#The locoregional risk factors of esophageal cancer exert significant effect on the recurrence of GTV in patients with N0 esophageal squamous cell carcinoma undergoing radical radiochemotherapy, which can be utilized as the predicting markers. Both GTV-D and GTV-V/L are significantly correlated the 10-year survival of patients.
ABSTRACT
Objective@#To evaluate the effect of different irradiation methods on the long-term prognosis of patients with clinical T2-3N0M0 esophageal squamous cell carcinoma, aiming to select the optimal treatment for these patients.@*Methods@#A total of 268 eligible patients admitted to our hospital from January 2007 to December 2012 were enrolled in this study. All patients were divided into the involved-field irradiation (IFI) and elective node irradiation (ENI) groups. The composition ratio, prognostic factors and adverse events were analyzed between two groups.@*Results@#The median overall survival (OS) time was 35.5 months (95%CI : 30.12-40.88) and the median disease-free survival (DFS) time was 23.5 months (95%CI: 19.00-28.00). According to the multivariate analysis results, all patients were assigned into two groups at a ratio of 1 vs.1(n=86 in each group). Multivariate analysis after propensity score matching (PSM) demonstrated that irradiation method was the independent factor of OS (P=0.038), and T stage and radiotherapy were the independent factors affecting DFS (P=0.002, 0.032). The incidence of ≥grade Ⅱ adverse events did not significantly differ between two groups (P=0.819, 0.756). However, patients with combined chemotherapy experienced more adverse events.@*Conclusion@#ENI can prolong the OS and DFS of patients with clinical T2-3N0M0 esophageal squamous cell carcinoma, and does not increase the incidence of severe adverse events.
ABSTRACT
Objective To investigate the association of local factors with local recurrence (LR) and distant metastasis ( DM) in patients with esophageal squamous cell carcinoma ( ESCC) who do not experience clinical metastasis.Methods A total of 236 eligible ESCC patients were analyzed retrospectively, and the association of lesion length on esophagography, maximum tumor diameter, and tumor volume with survival and treatment failure pattern was analyzed.Kaplan-Meier test and Cox regression were used for survival analysis and to identify prognostic factors.Results The 1-, 3-, and 5-year overall survival rates, LR rates, and DM rates were 88.6%,52.4%,30.2%, 15.5%,35.6%,45.8%, and 9.0%,22.2%, 30.6%, respectively.The multivariate analysis showed that short-term treatment outcome and maximum tumor diameter were independent prognostic factors for overall survival rate ( P=0.000, 0.019); sex, maximum tumor diameter, irradiation method, and short-term treatment outcome were independent prognostic factors for LR (P=0.039,0.003,0.045,0.000);maximum tumor diameter was the independence factor for DM (P=0.035).In the patients receiving elective nodal irradiation and involved-field irradiation, the maximum tumor diameter was the prognostic factor for LR (P=0.008,0.001), and the lesion length on esophagography, maximum tumor diameter, and tumor volume were prognostic factors for DM (P=0.009, 0.023,0.014).Conclusions In ESCC patients without clinical metastasis, local factors are significantly associated with LR and DM, among which maximum tumor diameter is the most important factor.
ABSTRACT
Objective To study the relationship between radiation gastritis ( RG ) caused by esophageal cancer radical postoperative prophylactic IMRT and the dose of gastric. Methods A total of 49 esophageal cancer patients received postoperative adjuvant radiatherapy after esophagectomy, we analysised the dose?volume histogram of treatment plan and the the occurrence of RG, To analysis those physical indicators may be related to the occurrence of RG. The of ROC curve to analysis the physical index of the occurrence of acute radiation gastritis, Chi square test is compared between groups, Logistic method was used to multivariate analysis. Results The whole group, a total of 19 cases ( 39%) patients with symptoms of acute RG level 2 or higher. The results of ROC curve analysis showed that the physical variables associated with the occurrence of RG include stomach Max,stomach Mean,LSTT5?LSTT40 and V5?V50.According to the ROC curve,the cutoff values of the physical parameters of the patients were grouped. The incidence of acute≥2RG in the group of above boundary value patients significantly higher than below boundary value group, the physical index of the differences between groups were significant (P=0. 000?0. 022),except V5.The results of Logistic multivariate analysis showed that LSTT5 and V40 were independent predictor of≥2 RG (P=0. 026,0. 001). Conclusions According to the results of this study,We should pay attention to the protection of the stomach in develop a treatment plan for the prevention of postoperative patients with esophageal cancer,dose?volume histogram can well predict the occurrence of RG. Stomach LSTT5 and V40 were independent predictor of≥2 RG.The results of this study need to be further studied.
ABSTRACT
Objective To measure the setup errors and organ movements of patients with esophagus carcinoma during radiotherapy and find a reasonable margin from the clinic target volume (CTV) to the planning target volume (PTV). Methods (1) Set-up veri cation: Forty-two cases of untreated esophageal cancer were enrolled into this study. The physicist firstly made the planning according to the doctor requests and ensured the best distribution at the target. Thereafter, the 0° and 90° digitally reconstructed radiograph (DRR) was transmitted to the iView GT workshop. Meanwhile, two copies of cross-cut electronic portal image (EPI) were required before radiotherapy. Two doctors confirmed the variance of the osteal mark from the EPI and DRR,and output a 3D direction (left to right, superior to inferior, anterior to posterior) of the setup errors through the iView GT software. (2)Breathing motion:Ten cases of untreated esophageal cancer were enrolled into this study.Three distinct breathing levels were deflned: FB (free breathing), EBH (expiration with breath-held) and IBH (inspiration with breath-held). We gave the treatment planning in FB, then by moving the isocenter to EBH and IBH, we recalculated the dose distribution without changing the field angle, shape and weighing (Mus). Displacements were analyzed at four points (anterior, posterior, right lateral and left lateral) and five levels of target (upper, quarter, isocenter, three-quarter and lower). Results (1) The systematic setup errors were -0.23 cm, -0.02 cm and -0.06 cm, and the random errors were 0.44 cm, 0.45 cm and 0.44 cm at the direction of left to right(LR), superior to inferior (SI), anterior to posterior(AP), respectively. (2) The organ movements were 0.3 cm, 0.6cm and 0.3cm at the LR, SI, AP, respectively. Conclusions As an alternative, the root-sum-of-squares of set-up error and organ motion are suggested by σtot=√ (σITV2+σSM2). The CTV to PTV margins are 0.8cm left to right, 0.78cm superior to inferior, 0.5cm anterior to posterior.
ABSTRACT
Objective Comparing the dosimetric characteristics of volumetric modulated arc therapy (VMAT) and constant dose rate intensity modulated arc therapy (IMAT) in esophagus cancer to evaluate the performance of the two different arc therapy delivery techniques.Methods 22 cases of esophageal cancer patients were selected for the planning comparison study.All plans were done for IMAT and VMAT treatment plans on Oncentra 4.1 treatment planning system,prescription dose of 2 Gy in total 30 fractions.Planning objectives for PTV were at least 95％ reached the prescription dose and V110 no more than 10％.The maximum dose of spinalcord below 45 Gy and double lung dose V20 ≤ 28％,V30 ≤ 18％ were constrained.Plans were evaluated based on the ability to meet the dose volume histogram.The dose homogeneity index (HI),radiation conformity index (CI),radiation delivery time,monitor units and γ pass rate were also compared.SPSS 19.0 software paired ttest analysis was carried out on the two sets of data.Results The results showed that the IMAT plans in terms of the PTV's CI (t =3.35,P=0.003),D2(t =-2.27,P=0.034) lung's V30(t =-2.46,P=0.023) were better than that of VMAT group.But the VMAT plans spinal's V40 (t =2.37,P =0.027),lung's V5 (t =2.43,P =0.024) were superior to that of IMAT plans.There were no significant differences between IMAT and VMAT plans in the average dose of PTV,CTV,GTV,heart,spinal cord,double lung and the γpass rate.Conclusion IMAT presents a slight improvement in the OAR sparing in high dose with shorter treatment time when compared to VMAT.While in terms of delivered MU and tissue of low dose irradiated area is higher than that of in VMAT.These two treatment methods all can meet the clinical demand,which should be selected according to the actual situation of the patient.
ABSTRACT
ObjectiveTo measure the setup errors with infrared marker-based positioning system (IM-BPS) and electronic portal imaging device (EPID) for patients with esophageal carcinoma and lung cancer and investigate the accuracy and practicality of IM-BPS. MethodsFrom January 2007 to January 2008, 40 patients with esophageal carcinoma and 27 patients with lung cancer received three-dimensional conformal radiotherapy or intensity-modulated radiotherapy, setup errors during the treatment were measured with IM-BPS and EPID, and the data of setup errors were compared with paired t-test and agreement with x2-test. ResultsIt takes 10 - 12 mins to complete the validating for each patient by EPID) system, while IMBPS system only needs 2 -5 mins. The mean setup errors along x, y and z-axis for patients with esophageal carcinoma measured by IM-BPS and EPID were 3.49 mm, 3. 19 mm, 3.31 mm and 4. 03 mm, 3.41 mm, 3.43 mm, respectively. For the patients with lung cancer, the setup errors were 4. 23 mm, 3.51 mm, 3. 39mm and 4. 85 mm, 3. 53 mm, 3.74 mm, respectively. The difference of setup errors meanured by the two systems was within 1 mm for 65％ esophageal carcinoma patients ( x2 =51.09, P =0. 000), and 55％ lung cancer patients ( x2 =53. 35, P =0. 000).Conclusions The measurement results of setup errors for patients with esophageal carcinoma and lung cancer show that IM-BPS is mostly better than EPID. Though validating for patients can be measured accurately and be well quality controlled, IM-BPS is used easily because of macroscopic, homely,spare time and real-time monitoring.
ABSTRACT
Objective To evaluate the respiration-induced target volume motion in 3D-CRT for mid-thoracic esophageal carcinoma in order to guide the radiation oncologist to choose the expansion marginfor ITV.Methods Ten patients with mid-thoracic esophageal carcinoma were scanned by multi-spiral CTsimulator respectively in free breathing(FB),breath.hold after normal inspiration and expiration(IBH and EBH)with the same scanning range.Then the CT images of three series were transfefred to the treatmentplanning system.The target volume was outlined following the same standard.The motion of the centerpoint of GTV,the center point of each slice of GTV and the edge of the GTV in selected slice weremeasured respectively to obtain the comprehensive value of GTV motion。in order to find the appropriate IMvalue according to the 95％confidence interval of the GTV motion.Results①The GTV motion betweenIBH and EBH was(0.19±0.16)cm in the left.right direction,(0.54±0.19)cm in the cranial andcaudal irection.and(0.16±0.14)cm in anterior.posterior directions for the center of GTV,.For thecenter point of each slice of GTV.they ere(0.19±0.15)cm,(0.54±0.16)cm,(0.16±0.13)cm in three directions above.respectively.For the edge of the GTV in selected slice.they were(0.26±0.19)cm,(0.54±0.18)cm,(0.24±0.19)cm,respectively.The comprehensive value of GTV motion between IBH and EBH was(0.23±0.17)cm,(0.54±0.17)cm,(0.21±0.17)cm.respectively.The 95％confidence interval was 0.21-0.25 cm.0.53-0.56 cm and 0.19-0.22 cm in three directions.②The direction of GTV motion：No motion was noticed in 8.2％.while 73.3％to the right side and 18.5％to the left side in the left-right direction when IBH were compared with EBH.100％were moved to caudal in the the cranial and caudal direction[(0.54±0.17)cm].In the anterior-posterior direction,no motion was noticed in 8.2％,while 16.6％to the posterior and 75.2％to the anterior when IBH were compared with EBH.③The GTV motion was correlated with the vafiance of 1ung volumes in IBH-EBH(r=0.683,P=0.032)and not with GTV volume and length.Conclusions Respiration can induce target volume motion in 3 DCRT for mid-thoracic esophageal carcinoma.Compared to EBH.the GTV tends to move to the caudal,the anterior and the ight side in IBH.
ABSTRACT
Objective To evaluate the respiration-induced dosimetric variance in 3DCRT for midthoracic esophageal carcinoma, in order to guide the radiation oncologist to choose the expansion margin. Methods Ten patients with mid-thoracic esophageal carcinoma were scanned by multi-spiral CT simulator respectively in free breathing ( FB), breath-hold after normal inspiration and expiration ( IBH and EBH )with the same scanning range. Then the CT images of three series were transferred to the treatment planning system. The target volume was outlined following the same standard. Plan1 was designed in the images of FB and transported completely to the images of IBH and EBH as Plan2 and Plan3 respectively to observe the dosimetric variance in target volume. Results For GTV, there was a statistical difference only in V100 of the three plans ( H = 6.423, P = 0.040 ) and no significant difference was found in other indexes. For CTV, the V100 and V95 were better in Plan1 (F=3.992, P=0.030; H=9.920, P=0.007) and no significant difference was found in other indexes. While ()TV, the Dmin, V100 and V95 was better in Plan1 ( F = 3.677, P = 0.039; F = 4.539, P = 0.020; H = 6.846, P = 0.033 ) and no significant difference was found in other indexes. There were no significant differences in all the indexes for the spinal cord and lung in the three plans. Conclusions The change in dose distribution was not so much with the standard expansion. It can meet the needs of clinical treatment.
ABSTRACT
Objective To study the correlation between dose-volummetrics and changes of pulmona- ry function tests(PFTs), and to study the ability of standard dose-volummetrics to predict these changes after radiotherapy. Methods Pulmonary function was measured in 39 patients with inoperable lung cancer one week before and 2-4 months after radiotherapy. The pulmonary function parameters were the forced vital ca- pacity(FVC), forced expiratory volume in ls (FEV 1.0) and diffusion capacity of carbon monoxide(DL- CO). Dose-volumrnetrics were V_(10), V_(15), V_(20), V_(25), V_(30), V_(35), V_(40), CTV_(100), CTV_(95), CTV_(90), CTV_(80), lung D_(mean), V_(eff) and NTCP. Pearson and line regression analysis was performed to determine whether the correlation exis- ted between the metrics and the changes of PFTs. Results No correlation was found between the dose- volummetrics and the changes in PFTs. Excluding patients(n=15) with pretreatment atelectasis, signifi- cant correlation was found between the dose-volummetrics (V_(20), V_(25), V_(30), V_(35), V_(40), GTV, V_(eff) and D_(mean)) and the PFTs changes(r=0.469-0.695, P≤0.05). Therefore, the re-expansion may have jesperdized the proper data to the present record. Multivariate analysis showed that V_(30) was the risk factor to affect the chan- ges of FEV 1.0 and DLCO(P=0.046、0.041). The pulmonary function of patients with V_(30)≥18% was worse than patients with V_(30)