Survival analysis of patients with non-surgical esophageal carcinoma receiving intensity-modulated radiotherapy (IMRT) alone / 中华放射医学与防护杂志

ABSTRACT

Objective:To evaluate the efficacy of target area of radical radiotherapy for inoperable esophageal carcinoma patients treated with intensity-modulated radiotherapy (IMRT).Methods:A retrospective analysis was performed on the clinical data of 564 Ⅰ-Ⅳ non-surgical esophageal cancer who received definitive intensity-modulated radiotherapy alone in our hospital from 2006 to 2015. Propensity score matching (PSM) was used to identify well-balanced patients for comparison. The Kaplan-Meier method was used to calculate local-regional failure-free survival (LRFFS), progression-free survival (PFS), overall survival (OS) rates and univariate analysis. The multivariate analysis of prognostic factors were tested by COX proportional hazard model.Results:The last follow-up time was December 2018, the median follow-up time was 99.7 (95% CI: 77.5-122.1) months. Follow-up rate was 95.9%. For the 564 patients, the 1-, 3-, 5- year LRFFS were 61.5%, 26.5%, 14.3%, PFS were 56.7%, 25.0%, 13.4%, OS were 73.0%, 31.1%, 16.8%. After PSM, for the elective-nodal irradiation (ENI) ( n=141) and involved-nodal irradiation (IFI) ( n=141) groups, the 1-, 3-, 5- year LRFFS were 68.8%, 34.2%, 19.1% vs. 65.2%, 32.1%, 17.9% ( P>0.05), PFS were 63.1%, 31.0%, 16.6% vs. 60.3%, 29.3%, 16.6% ( P>0.05), OS were 80.9%, 41.5%, 23.3% vs. 80.1%, 35.0%, 20.2% ( P>0.05). In multivariate analysis, tumor volume≤37 cm 3 and Ⅰ+ Ⅱ stage were independent factors for LRFFS, PFS and OS. Subgroup analysis showed that there were no significant differences in the survival rates between the ENI group and IFI group ( P>0.05). Comparing to the IFI group, ENI reduced the local-regional failure rate ( P=0.048). Conclusions:Using intensity-modulated radiation therapy alone for inoperable esophageal carcinoma, ENI can significantly reduce the local-regional failure rate, but not improve survival rates compared to the IFI.