Analysis of three-dimensional conformal radiotherapy for local recurrence of esophageal cancer after definitive radiotherapy

Abstract

Objective To evaluate the safety, clinical effect and prognosis of three-dimensional conformal radiotherapy (3DCRT) for local recurrent esophageal cancer after definitive radiotherapy. Methods From January 2010 to April 2014, the treatment effects of 46 patients received 3DCRT with local recurrent esophageal cancer after definitive radiotherapy in our hospital were analyzed retrospectively. The Log-rank test was used for univariate prognostic analysis, and the Cox regression model was used for multivariate prognostic analysis. Results Forty patients achieved radiotherapy, 6 patients did not finish radiotherapy. The total effective rate of 3DCRT was 80.0% (32/40). The overall 1- and 2-year survival rates were 47.5% (19/40) and 20.0% (8/40). During the radiation therapy, the incidence rates of grade 2+ 3 acute radiation-induced esophageal toxicity, radiation pneumonitis, hematopoietic toxicity reaction and cardiac toxicity were 47.5% (19 cases), 35.0% (14 cases), 15.0% (6 cases) and 10.0% (4 cases) respectively. There was no treatment-related death and no patients experienced any grade 4 toxicities. Univariate analysis results showed the age (χ2=8.432, P=0.015), interval time of radiotherapy (χ2=7.006, P=0.008), radiation dose (χ2=18.718, P=0.000), gross tumor volume (GTV) (χ2=10.121, P=0.006), adjuvant chemotherapy (χ2=5.014, P=0.025), tumor length (χ2=7.391, P=0.025), in-field failure (χ2=9.933, P=0.002), tumor control (χ2=14.665, P=0.001) were closely related with prognosis. Diseased region had a tendency to affect overall survival (χ2=5.493, P=0.064). Multivariate analysis results showed that age (χ2=4.759, P=0.029), interval time of radiotherapy (χ2=4.139, P=0.041), GTV (χ2=4.799, P=0.024), tumor control (χ2=4.501, P=0.030) were independent prognostic factors for overall survival. Conclusion To patients with local recurrent esophageal cancer after definitive radiotherapy, despite acute toxicity rate is high. 3DCRT is an alternative effective method, which can improve the short-term efficacy. The age, interval time of radiotherapy, GTV and tumor control are prognosis factors. Key words: Esophageal neoplasms; Radiotherapy; Prognosis; Recurrence