Efficacy and prognosis analysis of intensity-modulated radiotherapy in elderly patients with locally advanced esophageal cancer / 肿瘤研究与临床

ABSTRACT

Objective:To explore the efficacy and prognostic factors of intensity-modulated radiotherapy (IMRT) in elderly patients with locally advanced esophageal cancer.Methods:The clinical data of 87 elderly patients with locally advanced esophageal cancer who received IMRT and 79 elderly patients with locally advanced esophageal cancer who received three-dimensional conformal radiotherapy (3DCRT) from January 2005 to December 2015 in Changzhou Cancer Hospital Affiliated to Soochow University were retrospectively analyzed, and their efficacy and adverse reactions were observed. The log-rank test and Cox proportional hazards model were used for univariate and multivariate analyses to analyze the prognostic factors of patients receiving IMRT.Results:In the IMRT group, 27 cases (31.0%) achieved complete remission, and 60 cases (69.0%) achieved partial remission; in the 3DCRT group, 18 cases (22.8%) achieved complete remission, and 61 cases (77.2%) achieved partial remission. There was no statistical difference in the short-term efficacy (CR+PR) between the two groups ( χ2 = 1.43, P = 0.232). The 1-, 3-, and 5-year overall survival rates in the IMRT group were 77.0%, 46.0% and 23.0%, respectively, and the 3DCRT group were 70.1%, 40.5% and 10.1%, respectively. There was a statistical difference in the overall survival between the two groups ( χ2 = 4.89, P = 0.027). For elderly patients with locally advanced esophageal cancer who received IMRT, univariate analysis showed that gender, lesion location, T stage, gross tumor volume, and short-term efficacy were prognostic factors (all P < 0.05); multivariate analysis showed that lesion location, T stage, gross tumor volume, and short-term efficacy were independent prognostic factors (all P < 0.05). In the IMRT group, the incidence rate of ≥ grade 2 radiation pneumonitis was 10.3% (9/87), the incidence rate of ≥ grade 2 radiation esophagitis was 32.2% (28/87), the incidence rate of leukopenia was 18.4% (16/87), and the incidence rate of hemoglobin reduction was 7.0% (6/87), and there was no statistical difference in the incidence of acute adverse reactions between the IMRT group and the 3DCRT group (all P > 0.05). Conclusions:IMRT has more advantages than 3DCRT in the treatment of elderly patients with locally advanced esophageal cancer, especially those with upper cervical and thoracic lesion, T 1-3 stage, gross tumor volume ≤40 cm 3, and complete remission in a short term can benefit from it, and the adverse reactions are mild.