Survival comparison of three-dimensional radiotherapy alone with concurrent chemoradiotherapy for non-surgical esophageal carcinoma

Abstract

Objective To compare the survival between three-dimensional radiotherapy (3 DRT)alone and concurrent chemoradiotherapy (C+3 DRT) for non - surgical esophageal carcinoma. Methods Four hundred and eighty patients with esophageal squamous cell carcinoma who were treated with definitive 3 DRT or C+3 DRT in our institution from 2002 to 2012 were collected and 296 out of them were equally divided into 3 DRT group and C+3 DRT group. Survival comparison between the two groups was made by propensity score matching method. Patients were mainly given paclitaxel and platinum weekly in C+3DRT. Results The numbers of samples at 3 and 5 years were 58 and 48 in the 3DRT group, and 58 and 52 in the C+3DRT group. The 3-and 5-year overall survival (OS) rates were 32.6% and 22.1% in the 3 DRT group, and 35.1% and 26.5% in the C+3DRT group (P=0.463). The 3-and 5-year progression-free survival (PFS) rates were 27.8% and 19.8% in the 3DRT group, and 30.7% and 25.8% in the C+3DRT group (P=0.637). In the 3DRT and C+3DRT groups, patients treated with 60.0 -70.0 Gy had similar OS rates (25.6% vs. 25.3%, P=0.833) , PFS rates (22.7% vs. 25.2%, P=0.999) , and incidence rates of hematogenous metastasis (23.4% vs. 24.1%, P=0.899) at 5 years. Patients treated with 50.0 -59.9 Gy had significantly higher 5-year OS and PFS rates in the C+3 DRT group than in the 3DRT group (32.3% vs. 12.0%, P=0.030; 24.1% vs. 10.6%, P=0.087). In the 3DRT group, patients treated with 60.0 -70.0 Gy had significantly higher 5-year OS and PFS rates than those treated with 50.0 -59.9 Gy (P=0.024, P=0.041). In the C+3DRT group, patients treated with 60.0 -70.0 Gy and 50.0 -59.9 Gy had similar 5-year OS and PFS rates (P=0.791, P=0.984). The incidence rates of adverse reactions, such as esophagitis and leukopenia, in the C+3DRT group were significantly higher than those in the 3DRT group (P=0.000, P=0.005). However, those adverse reactions could be tolerated by patients. Conclusions For patients with non-surgical esophageal carcinoma, a low dose in definitive C+3DRT is recommended.60-70 Gy in 3DRT alone can also achieve a promising survival in patients who cannot receive C+3DRT, which still needs to be confirmed by randomized studies. Key words: Esophageal neoplasms/three-dimensional radiotherapy; Esophageal neoplasms/concurrent chemoradiotherapy; Prognosis