Prognostic analysis of cervical, upper-thoracic, middle-thoracic, and lower-thoracic esophageal cancers in 781 patients mainly receiving three-dimensional radiotherapy

Abstract

Objective To investigate the different therapeutic effects of three-dimensional radiotherapy in the patients with cervical,upper-thoracic,middle-thoracic,and lower-thoracic esophageal cancer (EC) and the prognostic factors.Methods From September 2003 to January 2009,781 patients with T1-T4 esophageal squamous cell carcinoma received conventional fractionated three-dimensional radiotherapy.Of all the patients,31 had cervical EC,210 had upper-thoracic EC,427 had middle-thoracic EC,and 113 had lower-thoracic EC.The prescribed doses ranged from 50 Gy to 70 Gy,with a median value of 60 Gy.A total of 197 patients received chemotherapy.Kaplan-Meier method was used to calculate the survival rate; Logrank test was used for univariate prognostic analysis; Cox regression test was used for multivariate prognostic analysis.Results The follow-up rate was 95.8％.A total of 128 patients were followed up for more than 5 years.The 1-,3-,and 5-year survival rates of the patients with cervical EC,upper-thoracic EC,middle-thoracic EC,and lower-thoracic EC were 83.9％,67.4％,and 58.1％,80.4％,47.4％,and 35.5％,63.7％,30.2％,and 21.9％,and 69.9％,33.6％,and 28.8％,respectively.There were no significant differences in survival rate between the cervical EC cases and upperthoracic EC cases (x2 =3.03,P =0.082) and between the middle-thoracic EC cases and lower-thoracic EC cases (x2 =1.35,P =0.246).But the cervical EC cases showed significantly higher survival rate than the middle-thoracic and lower-thoracic EC cases (x2 =11.64,P =0.001 ; x2 =7.37,P =0.007),and so was the comparison between upper-thoracic EC cases and middle-thoracic and lower-thoracic EC cases (x2 =17.74,P =0.000; x2 ＝ 4.41,P =0.036).The patients with cervical EC and upper-thoracic EC showed significantly higher 1-,3-,and 5-year survival rates than those with middle-thoracic EC and lower-thoracic EC (80.8％,50.0％,and 38.7％ vs.65.0％,30.9％,and 23.4％,x2 =23.01,P =0.000).Compared with those with cervical EC and upper-thoracic EC,the patients with middle-thoracic EC and lower-thoracic EC showed significantly larger gross tumor volume (GTV) (48.22 cm3 vs.34.74 cm3,Z =5.80,P =0.000),significantly larger lesion length (5.20 cm vs.4.80 cm,Z =2.36,P =0.018),and significantly older age (67 years vs.63 years,Z =2.82,P =0.005).Multivariate analysis showed that lesion length (measured by barium meal),tumor location,non-surgical N stage,and GTV were prognostic factors (x2 =4.13,P =0.042 ;x2 =10.01,P =0.002 ; x2 =10.34,P =0.001 ; x2 =11.19,P =0.001).Conclusions The therapeutic effect of three-dimensional radiotherapy is better in the patients with cervical EC and upperthoracic EC than in those with middle-thoracic EC and lower-thoracic EC. Key words: Esophageal neoplasms/radiotherapy; Radiotherapy, three-dimensional; Prognosis