ABSTRACT
Objective:To explore the effects of clinical characteristics and dosimetric factors on the survival and prognosis of patients with locally advanced thoracic esophageal squamous cell carcinoma after concurrent chemoradiotherapy (CCRT).Methods:A total of 158 patients with locally advanced thoracic esophageal squamous cell carcinoma undergoing CCRT in Shandong Cancer Hospital, Anyang Cancer Hospital of Henan Province, Tengzhou Central People′s Hospital of Shandong Province and the First Affiliated Hospital of China Medical University from August 2015 to October 2018 were selected as the research subjects. These patients were divided into standard-dose group (50.0-50.4 Gy, n=59) and high-dose group (>50.4 Gy, n=99) according to the radiotherapy dose. The overall survival (OS) and progression-free survival (PFS) of the two groups after treatment were compared. Kaplan-Meier method was used to calculate survival rate and survival comparison was performed by log-rank test. Cox proportional hazard regression model was used to analyze the adverse prognostic factors. The receiver operating characteristic (ROC) curve was used to analyze the predictive value of lung V 30 for patient prognosis. Results:In 158 patients with locally advanced esophageal squamous cell carcinoma, 19 cases (12.03%) had complete remission after CCRT, 103 cases (65.19%) had partial remission, 27 cases (17.09%) had stable disease, 9 cases (5.70%) had progression disease, and the total effective rate was 77.22%. The median OS of 158 patients was 41 months (95% CI: 25-57 months), and the 1- and 3-year OS rates were 76% and 51%, respectively. The median PFS was 24 months (95% CI: 13-35 months), and the 1- and 3-year PFS rates were 60% and 39%, respectively. The 1- and 3-year OS rates in the standard-dose group were 74% and 56%, and those in the high-dose group were 77% and 49%, with no statistically significant difference ( χ2=0.300, P=0.584). The 1- and 3-year PFS rates in the standard-dose group were 62% and 37%, and those in the high-dose group were 59% and 40%, with no statistically significant difference ( χ2<0.001, P=0.990). Univariate analysis showed that the length of the lesion, N stage, clinical stage, short-term efficacy of CCRT, planning target volume (PTV) D max, gross tumor volume (GTV) D mean, V 5, V 10, V 20, V 30, D mean of the left, right and bilateral lung were all the prognostic factors for OS and PFS (all P<0.05). Multivariate analysis showed that the length of the lesion ( HR=2.226, 95% CI: 1.244-3.985, P=0.007), N stage ( HR=2.819, 95% CI: 1.137-6.991, P=0.025), clinical stage ( HR=1.897, 95% CI: 1.079-3.334, P=0.026), short-term efficacy of CCRT ( HR=1.805, 95% CI: 1.250-2.606, P=0.002), left lung V 10 ( HR=0.811, 95% CI: 0.668-0.986, P=0.035), left lung V 30 ( HR=0.617, 95% CI: 0.408-0.933, P=0.022), right lung V 20 ( HR=2.067, 95% CI: 1.010-4.231, P=0.047), bilateral lung V 10 ( HR=1.299, 95% CI: 1.016-1.662, P=0.037) and bilateral lung V 30 ( HR=2.368, 95% CI: 1.142-4.910, P=0.021) were independent prognostic factors affecting OS. N stage ( HR=2.433, 95% CI: 1.201-4.931, P=0.014), short-term efficacy of CCRT ( HR=2.067, 95% CI: 1.391-3.071, P<0.001) and bilateral lung V 30 ( HR=0.113, 95% CI: 0.018-0.719, P=0.021) were independent prognostic factors affecting PFS. The ROC curve for predicting OS and PFS showed that the optimal cut-off value of bilateral lung V 30 was 9.5%. Conclusion:Compared with the standard-dose group, increasing the dose of radiotherapy fails to improve the long-term survival of patients with locally advanced thoracic squamous cell carcinoma. Lesion length, N stage, clinical stage, short-term efficacy of CCRT, left lung V 10 and V 30, right lung V 20 , bilateral lung V 10 and V 30 are independent prognostic factors for OS in patients with locally advanced thoracic squamous cell carcinoma. N stage, short-term efficacy of CCRT and bilateral lung V 30 are independent prognostic factors for PFS. When bilateral lung V 30≤9.5%, the patients′ OS and PFS will benefit from the treatment.
ABSTRACT
Objective:To analyze the clinical and physical tactors associated with acute bone marrow suppression in concurrent chemo-radiotherapy for rectal cancer and to provide a reference standard for the best clinical treatment plan. Methods:Retrospective analy-sis was performed on 62 patients with rectal cancer who received concurrent radiotherapy and chemotherapy in our department. The pelvis was contoured for each patient in the radiotherapy treatment planning system and divided into three subsites: lumbosacral spine, ilium, and lower pelvis. Prognostic clinical and physical factors were analyzed by univariate and multivariate analyses. Evaluated prognostic clinical factors included sex, age, clinical stage, original hemoglobin levels, and chemotherapy, operation, and radiation modes;physical factors included V5, V10, V15, V20, V25, V30, V35, V40, V45, V50, Dmax, and Dmean of lumbosacral spine, ilium, low-er pelvis, and pelvis. Results:The percentage of patients who developed acute bone marrow suppression (≥2 grade) was 61.3%(38/62).Univariate analysis of related factors revealed statistically significant differences were sex, chemotherapy, lumbosacral spine V45, il-ium V20, and ilium V30. Multivariate logistic regression analysis indicated that chemotherapy and ilium V30 are the risk factors for acute bone marrow suppression. The receiver operating curve showed that the threshold of ilium V30 was 44%. Conclusion:Acute bone marrow suppression is influenced by more than one factor;local control rate of the tumor and acute bone marrow suppression are tradeoffs in rectal cancer treatment. An appropriate chemotherapy method should be selected, and ilium V30 must be maintained below 44%to prevent bone marrow suppression in rectal cancer patients.