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Objective To evaluate the prognostic significance of 3 clinical stage system in 3-dimensional conformal radiotherapy (3DCRT) for esophageal squamous cell carcinoma. Methods From January 2004 to August 2007, 179 cases of esophageal squamous cell carcinoma were treated with 3DCRT.Before radiation, each patient was staged with UICC 2003 TNM stage, stage of Chinese esophageal cancer cooperation group (cooperation group' stage), and Zhu's clinical stage respectively. Concordance of each clinical stage and prognosis was analyzed with SPSS 11.5. Results In 179 cases of esophageal cancer,Concordance was better in T stage ( Kappa = 0. 271 ) than in TNM stage ( Kappa = 0. 167 ) between cooperation group' stage and Zhu's stage. Among them, 98 cases was staged with UICC stage, concordance of T stage was better between UICC-T and cooperation group' T stage (Kappa =0. 261 ) than between UICCT and Zhu's T stage (Kappa = 0. 045 ) ;concordance of TNM stage was better between UICC-TNM and Zhu's TNM stage ( Kappa = 0. 597 ) than between UICC-TNM and cooperation group' TNM stage ( Kappa =0. 299 ). With multivariate analysis, T ( χ2 value is 11.58, 26. 00 and 51.05, all P ＜ 0. 01 ), N ( χ2 value is 15.28, 16. 10 and 16. 10,all P＜0. 01), M (χ2 value is 5.59, 27.78 and 27.78,all P＜0. 01), and TNM (χ2 value is 15.77, 34,35 and 51. 10,all P＜0. 01 ) stage in 3 kinds of clinical stage were independent prognostic factors. In UICC stage, T1-T3 was difficult to definite and the prognosis was not significantly different in T1 -T3 stage. Conclusions In this study, 3 kinds of clinical stage could evaluate prognosis of esophageal cancer after radiotherapy;cooperation group' stage and Zhu's stage need further application, with further accuracy needed.
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Objective To analyze the prognosis of 225 patients according with clinical staging of esophageal carcinoma treated with non-surgical methods, and investigate the practicality and predictive value of the clinical staging. Methods From March 2001 to July 2007, 225 patients with esophageal carcinoma received 3DCRT treatment. The prescribed doses were ranged from 5000 -7000 cGy with the median dose of 6400 cGy, 25 patients received accelerative radiation of 300 cGy per fraction after conventional radiotherapy of 3000 -4000 cGy, 57 patients received concurrent chemotherapy with or without consolidation chemotherapy. All the patients were divided into subgroups of different T stages, different N stages and different TNM stages. Local control rates, survival rates were observed and Cox regression analysis were performed to search valuable prognostic factors. Results The following-up rate was 99. 6%. The 3-and 5-years following-up number were 116 and 33 patients, respectively. The 1 -,3-,and 5-year local control rates were 77. 2% ,48.2% and 34. 5%, respectively. The 1-,3-,and 5-year overall survival rates were 68.4% ,33.7% and 20. 8%, respectively. The median survival time was 20 months. There were significant difference between survival curves for T1-4 stages, N0-2 stages and Ⅰ - Ⅲ stages with x2 value of 13.07,20. 49 and 17.16, with P value of 0. 004,0. 000 and 0. 000, respectively. For the group of stage Ⅰ, Ⅱ and Ⅲ, the 1-,3-,and 5-year survival rates were 89.4% ,56. 1% ,and 37.8% ;69.6% ,32. 4% ,and 18.0%and 47. 2%, 19. 5%, and 13. 0%, respectively. According to the result of Cox regression analysis, the tumor length of CT scan, clinical N stage, short term restlt were most valuable predictive factors.Conclusions The clinical staging of esophageal carcinoma treated with non-surgical methods could predict the prognosis accurately, clinical N stage may have more closely association with prognosis, however, some details of the staging program need more consummate.
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Objective To analyze the result of3-dimensional conformal radiotherapy(3DCRT)and operation of early stage esophageal carcinoma. Methods Ninety-three patients with early stage esophageal carcinoma were treated with 3DCRT from October 2000 to December 2006. The total dose was 50 -70 Gy/25 -35F/5 -7 w. Toxicities and survival rates were evaluated by Kaplan Meier method and the factors of death were analyzed. Results In the 3DCRT group, 79, 42 and 13 cases were followed up for at least 1-,3-,and 5-year, respectively. Follow-up rate was 100%. The 1-, 3-, and 5-year actuarial survival rates were 84% ,50% and 29%, respectively, with a median survival time of 37.0 months. The 1-, 3-, and 5-year local control rates were 83% ,63% and 55% ,respectively. The 1-, 3-, and 5-year disease free survival rates were 83% ,49% and 28%, respectively. The 1-, 3-, and 5-year metastasis free survival rates were 84%,51% and 28%, respectively. There were significant influence on the prognosis of age, the state of food taken before treatment, the pain of chest and back, the disease region, the tumor length in x-ray, the maximuminfiltration depth in CT scan, the preliminary curative effect and the no operation in univariate analysis. The Cox multivariate model showed that age, the pain of chest and back, the disease region and the tumor length in X-ray were independent prognostic factors. In the operation group, 80,46 and 16 cases were followed up for at least 1-,3-,and 5-year, respectively. Follow-up rate was 100%. The 1-, 3-, and 5-year actuarial survival rates were 86% ,62% and 41%, respectively, with a median survival time of 47.8 months. Conclusion Three-dimensional conformal radiotherapy is one of the best radiation treatment regimen for early esophageal carcinoma.
