ABSTRACT
Objective To compare the clinical efficacy and safety between induction chemotherapy (IC) followed by concurrent chemotherapy (CRT) and CRT alone in patients with inoperable thoracic esophageal squamous cell carcinoma (ESCC).Methods Between 2002 and 2015,clinical data of 267 thoracic ESCC patients undergoing definitive CRT based on docetaxel combined with cisplatin were retrospectively analyzed.Through a matched case-control study,85 patients receiving IC combined with CRT were matched to those undergoing CRT alone at a ratio of 1vs.1,according to age,gender,performance status,tumor location,tumor length,and TNM staging as the matching factors.Clinical efficacy and safety between two groups were statistically compared.Kaplan-Meier survival analysis was used to analyze the survival.The log-rank test was adopted to examine within-group differences.The Cox regression model was used for multivariate analysis.Results The median follow-up time for 170 patients was 18 months (range,3-72 months).The overall objective response rates in the IC and CRT groups were 74.1％ and 58.8％(P=0.035).The 3-year overall survival (OS) and progress-free survival (PFS) rates in the IC group were 44.2％ and 34.8％,significantly higher than 29.7％ and 15.4％ in the CRT group (P=0.028,P=0.015).Subgroup analysis revealed that patients responsive to IC obtained significantly better OS (P=0.002),PFS (P=0.001),and local recurrence-free survival (LRFS)(P=0.002) compared with the IC non-responder,whereas the distant metastasis-free survival (DMFS) did not significantly differ (P=0.166).The incidence rate of grade 3-4 leukopenia in the IC group was significantly higher than that in the CRT group (38.8％ vs.24.7％,P=0.048).Multivariate analysis revealed that age and the addition of IC were independent prognostic factors for OS (P=0.003,0.016).Conclusions Compared with concurrent CRT,IC in combination with CRT can yield better short-term efficacy and longer survival for ESCC patients.The risk of hematological toxicity in the IC group is relatively higher but tolerable.Prospective randomized trials are required to confirm the clinical efficacy and safety of IC for thoracic ESCC patients.
ABSTRACT
Objective@#To investigate the effect of nutritional risk screening tool (NRS-2002) upon the clinical efficacy and survival outcomes in patients with unresectable locally advanced esophageal squamous cell carcinoma (LAESCC) receiving concurrent chemoradiotherapy.@*Methods@#Clinical data of 105 LAESCC patients treated with concurrent chemoradiotherapy in Zhejiang Provincial People′s Hospital from January 2013 to December 2015 were retrospectively analyzed. Nutritional status screening was performed using the NRS-2002 scale. The rate comparison was analyzed by using chi-square test. Kaplan-Meier survival analysis was adopted to calculate the survival rate. Log-rank test was utilized to statistically analyze the differences in survival outcomes. Cox regression model was used for uni-and multi-variate analyses.@*Results@#Prior to concurrent chemoradiotherapy, 37.1% of patients had the nutritional risk. Patients with NRS-2002 score ≥3 had a significantly higher incidence of ≥ grade 3 toxic reactions compared with their counterparts obtaining NRS-2002 score of 1-2(P=0.007). The median overall survival (OS) and progression-free survival (PFS) of all patients were 17.0 and 11.8 months. The OS and PFS of patients with NRS-2002 score ≥ 3 were significantly lower than those of their counterparts obtaining NRS-2002 score of 1-2(both P=0.000). Multivariate analysis demonstrated that NRS-2002 score of ≥3 was an independent prognostic factor for OS (P=0.000) and PFS (P=0.001).@*Conclusions@#NRS-2002 tool reveals that patients with esophageal cancer possess a relatively high nutritional risk. Prior to treatment, NRS-2002 score of ≥3 is significantly correlated with an increasing risk of toxic reactions and decreasing survival rate, which is worthy of subsequent investigation.
ABSTRACT
Objective To investigate the feasibility and value of diffusion-weighted imaging (DWI) in the prediction and early assessment of response to concurrent chemoradiotherapy (CCRT) for esophageal cancer.Methods A total of 40 patients with pathologically confirmed esophageal cancer who received CCRT were included in the study.Routine 3.0 T MRI and DWI were performed at different time points of treatment.The RECIST standard was adopted to evaluate short-term outcomes and divide the patients into remission group (complete remission and partial remission) and non-remission group (stable disease and progressive disease).Group t-test was used for between-group comparison.The receiver operating characteristic (ROC) curve was used to analyze the change rates of apparent diffusion coefficient (ADC) value at different time points of treatment.Results There were 30 patients in the remission group and 10 patients in the non-remission group.The remission group had a significantly higher increase in ADC value than the non-remission group by the end of the first week of treatment (P =0.000).The maximum diameters of tumors for the emission group and non-remission group at the end of the first week of treatment were not significantly different from those before treatment (66.10 mm vs.62.63 mm,P =0.407 ; 70.90 mm vs.68.30 m,P =0.552).The ADC value before treatment had a negative correlation with the reduction rate of the maximum diameter of tumor (r =-0.680,P =0.000).The area under the ROC curve was the largest at the end of the first week of treatment (Az =0.783).If using 15.5 ％ increase in ADC value by the end of the first week as the threshold value for evaluating tumor response,the sensitivity,specificity,positive predictive value,and negative predictive value were 86.7％,70.0％,89.7％,and 63.6％,respectively.Conclusions DWI can be used as a new imaging method for the prediction and early assessment of the response to CCRT for esophageal cancer.The change rate of ADC value by the end of the first week of treatment is sensitive in assessing treatment response,so ADC value can be monitored at this time point.