Long-term efficacy of concurrent chemoradiotherapy at different radiotherapy doses in treatment of esophageal carcinoma

Abstract

Objective To compare the local control (LC), long-term overall survival (OS), and clinical adverse reactions in esophageal carcinoma patients receiving concurrent chemoradiotherapy at different radiotherapy doses. Methods A total of 373 esophageal carcinoma patients who received concurrent chemoradiotherapy in our hospital during 2004-2013 were included in this retrospective study. These patients were divided into 60 Gy group (n=119) based on the dose of radiation. The Kaplan-Meier method was used to calculate LC and OS rates; the log-rank test was used for survival comparison and univariate prognostic analysis; the Cox model was used for multivariate prognostic analysis. Results The 3-, 5-, 7-, and 10-year sample sizes were 97, 96, 56, and 38 in the 60 Gy group. The 3-, 5-, 7-, and 10-year LC rates were 55.3%, 51.4%, 48.9%, and 48.9% in the 60 Gy group (P=0.020). The 3-, 5-, 7-, and 10-year OS rates were 35.4%, 26.1%, 22.0%, and 22.0% in the 60 Gy group (P=0.000). The univariate analysis showed that for stage Ⅱ esophageal carcinoma patients with gross tumor volume (GTV) ≤44 cm3, the LC rate was higher in the 60 Gy group than in the 44 cm3, the LC rate was higher in the 60 Gy than in the>60 Gy group (P=0.011, 0.015), and the OS rate was higher in the 60 Gy group than in the other two groups (P=0.045, 0.006 and P=0.033, 0.002). The incidence rates of acute radiation esophagitis and radiation pneumonia were significantly higher in the>60 Gy group than in the other two group (P=0.007, 0.033). Furthermore, the multivariate analysis indicated that radiotherapy dose, T stage, and N stage were independent prognostic factors for esophageal carcinoma (P=0.004, 0.008, 0.037). Conclusions Concurrent chemoradiotherapy at 60 Gy is most efficacious for patients with esophageal carcinoma, and the radiotherapy dose of>60 Gy significantly increases the incidence of adverse reactions. Key words: Esophageal neoplasms/radiotherapy; Esophageal neoplasms/chemotherapy; Prognosis