Long-term efficacy of intensity-modulated radiotherapy with or without chemotherapy in treatment of esophageal carcinoma: an analysis of 349 patients

Abstract

Objective To observe the efficacy and adverse reactions of intensity-modulated radiotherapy (IMRT) with or without chemotherapy in the treatment of esophageal carcinoma, and to explore the influencing factors for prognosis. Methods The short-term outcomes and acute adverse reactions in 349 patients with esophageal carcinoma who received IMRT with or without chemotherapy from 2006 to 2012 were retrospectively analyzed. The 1-, 3-, and 5-year local control (LC) rates and overall survival (OS) rates were calculated with the Kaplan-Meier method. The influencing factors for survival were analyzed using the Cox regression model. Results The sample sizes at 3 and 5 years were 174 and 63, respectively. For all patients, the 1-, 3-, and 5-year LC rates were 72. 9%, 61. 2%, and 58. 4%, respectively, and the 1-, 3-, and 5-year OS rates were 66. 5%, 39.1%, and 24%, respectively. According to the results of subgroup analysis, the 1-, 3-, and 5-year LC and OS rates in patients with a tumor volume of < 54. 73 cm3 were significantly higher than those in patients with a tumor size of ≥54. 73 cm3 ( P=0. 001 and 0. 000). There were no significant differences in 1-, 3-, and 5-year LC rates between patients with and without lymph node metastasis (P= ?). However, the 1-, 3-, and 5-year OS rates were significantly lower in patients with lymph node metastasis than in patients without lymph node metastasis (62. 7% vs. 83.1%; 35. 9% vs. 53. 3%; 20. 4% vs. 38. 3%; P= 0.003). There were significant differences in the 1-, 3-, and 5-year LC and OS rates between patients with complete response, partial response, and no response (P= 0. 000 and 0. 000). The incidence rates of grade ≥ 2 acute radiation pneumonitis and grade ≥ 3 acute radiation esophagitis were 11. 3% and 9.0%, respectively. The tumor volume, short-term outcome, and lymph node metastasis were the influencing factors for OS (P= 0. 038, 0. 000, and 0. 008). Conclusions IMRT with or without chemotherapy is effective and safe in the treatment of esophageal carcinoma. The prognosis becomes poor along with increased tumor volume and regional lymph node metastasis. The evaluation of short-term outcomes is closely correlated with LC and OS. Key words: Esophageal neoplasms/radiotherapy; Radiotherapy, intensity-modulated; Prognosis