Abstract
Aim: To evaluate long-term outcome and prognostic factors of stage III esophageal cancer after definitive radiotherapy using three dimensional conformal radiotherapy (3DCRT) or intensity-modulated radiotherapy (IMRT) techniques.Methods: Patients with T3N1M0/T4N0-1M0 esophageal squamous cell carcinoma (ESCC) treated with definitive radiotherapy from 2002 to 2016 in 10 Chinese medical centers were retrospectively analyzed. Overall survival (OS) and progression-free survival (PFS) rates were calculated. Prognostic factors were analyzed by Log-rank test and multivariable Cox model.Results: Survival data of 1,450 patients were retrospectively collected. With a median follow-up time of 65.9 months, 1-, 3-, and 5-year OS rates were 69.3, 36.7, and 27.7%, respectively, and PFS rates were 58.6, 32.7, and 27.4%, respectively. Univariable analyses showed that gender, age, lesion location, lesion length, largest tumor diameter, lymph node metastasis, gross tumor volume, EQD2, short-term response, and concurrent chemotherapy were prognostic factors for OS. Multivariable analyses showed that lesion location, T-classification, GTV size, EQD2, and short-term response to RT were independent prognostic factors for OS, and tumor diameter, GTV size, and short-term response were independent prognostic factors for PFS.Conclusions: This study demonstrated that definitive radiotherapy using 3DCRT and IMRT provides promising outcomes for locally advanced ESCC.
Highlights
This study demonstrated that definitive radiotherapy using 3DCRT and intensity-modulated radiotherapy (IMRT) provides promising outcomes for locally advanced Esophageal squamous cell carcinoma (ESCC)
Esophageal squamous cell carcinoma (ESCC), a major histopathologic subtype of esophageal cancer, is an aggressive disease with more than 50% of patients diagnosed at the unresectable stage [1]
Italian Association of Radiotherapy and Clinical Oncology (AIRO) has conducted a systematic review to examine efficacy of brachytherapy in esophageal cancer compared with other treatments and found that brachytherapy group had a median dysphagia-free survival (DyFS) of 99 days [9]
Summary
Esophageal squamous cell carcinoma (ESCC), a major histopathologic subtype of esophageal cancer, is an aggressive disease with more than 50% of patients diagnosed at the unresectable stage [1]. Definitive chemoradiotherapy (CRT) is recommended as a standard regimen for patients with locally advanced, unresectable esophageal cancer [2, 3]. Intraluminal brachytherapy is recommended for patients unable to tolerate definitive CRT or to alleviate dysphagia in people with advanced esophageal cancer [7]. In addition to palliative aim, brachytherapy can be used for boost after EBRT or reirradiation Because it offers a remarkable dose gradient allowing best organ at risk sparing, with an encouraging rate of long survivors [10]. The current multicenter study conducted by 3JECROG aims to retrospectively report long-term outcome and prognostic factors of definitive 3DCRT/IMRT alone or in combination with chemotherapy in locally advanced ESCC of stage III
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