Clinical Features And Treatment Outcomes Of Patients With Cervical Esophageal Cancer

Part Ⅰ:Primary radiotherapy compared with primary surgery in cervical esophageal cancerPurpose:This study aims to evaluate treatment outcomes of primary radiotherapy and primary surgery in patients with cervical esophageal cancer (CEC).Patients and methods:A total of224patients with CEC between2001and2012were eligible for study inclusion. One hundred and sixty-one patients who received primary radiotherapy were assigned to the primary radiotherapy group (RT±S) including133patients received radiotherapy alone or concurrent chemoradiotherapy and28patients received preoperative radiotherapy plus surgery. Sixty-three patients who received primary surgery were assigned to primary surgery group (S±RT) including27patients received surgery alone and36patients received surgery plus postoperative radiotherapy. A separate analysis using matched cases between primary radiotherapy group and primary surgery group was conducted.Results:The median follow-up time was15.1months. The overall2-year local failure-free survival(LFFS), regional failure-free survival(RFFS), distant failure-free survival(DFFS), and overall survival(OS) rate for patients with primary radiotherapy and primary surgery was69.9%and68.6%,79.5%and69.8%,74.3%and62.5%,49.3%and50.7%, respectively (p>.05). Matched cases analysis did not show a statistical difference in terms of LFFS, RFFS, DFFS and OS between the groups.Conclusions:With respect to the potential for larynx preservation, primary radiotherapy was recommended for CEC and surgery was offered for patients with no response to preoperative radiotherapy. Part Ⅱ:Definitive radiotherapy for cervical esophageal carcinomaPurpose:This study aims to analyze the outcome in cervical esophageal cancer patients treated with definitive radiotherapy (RT).Patients and methods:A total of115patients with cervical esophageal cancer treated with definitive RT during January2001through April2012in our centre were analyzed. Eighty patients received radiotherapy alone and35patients received concurrent chemoradiotherapy with cisplatin administered either weekly (30mg/m2) or every3weeks (80mg/m2).Results:The median follow-up time was17.1months. For all patients, the overall2-year local failure-free survival, regional failure-free survival, distant failure-free survival, and overall survival rate was68.3%,83.3%,75.7%and47.6%, respectively.Conclusions:Definitive RT accomplished a satisfactory local control rate and contributed to organ preservation for patients with cervical esophageal cancer. Part Ⅲ:Pattern of failure in surgical treated patients with cervical esophageal squamous cell carcinomaPurpose:The aim of this study was to analyse the pattern of failure in patients who have undergone surgical resection for cervical esophageal squamous cell carcinoma.Patients and methods:Sixty-two patients who had undergone surgical resection of cervical esophageal squamous cell carcinoma from January2001to April2012. Sites of failure were documented.Results:Twenty-nine patients had developed treatment failure. Of the29patients,14,13, and14had developed local failure, regional failure, and distant metastasis, respectively. The median time to local failure was6.8(2.5-23.0) months. The median time to regional failure was7.1(1.87-22.8) months. Of the13regional failure, the images of2patients were lost, the other11regional failure included left lateral nodal disease at level Ⅱ(n=2), level Ⅲ(n=4), level Ⅳ(n=7); right lateral nodal disease at level Ⅱ(n=2), level Ⅲ(n=3), level Ⅳ(n=3); and level Ⅵ(n=4). The overall2-year local failure-free survival rate and regional failure-free survival rate for patients with stage Ⅱ and stage Ⅲ was79.6%and58.6%(p=.039),79.6%and59.6%(p=.054), respectively.Conclusions:The pattern of failure of cervical esophageal squamous cell is characterised by early locoregional failure especially in patients with stage Ⅲ. Part Ⅳ:Intensity-modulated radiotherapy for cervical esophageal squamous cell carcinoma:clinical outcomes and patterns of failurePurpose:The aim of this study is to report clinical outcomes and patterns of failure for these patients with cervical esophageal squamous cell carcinoma (CESCC) treated with Intensity-modulated radiotherapy (IMRT).Patients and methods:A total of64patients with cervical esophageal cancer treated with definitive IMRT during May2005through March2012in our centre were analyzed. Forty-two patients received radiotherapy alone and22patients received concurrent chemoradiotherapy with cisplatin administered either weekly (30mg/m2) or every3weeks (80mg/m2). The location and extent of locoregional failures were transferred to the pretreatment planning computed tomography for dosimetry analysis.Results:The median follow-up time was14.5months. For all patients, the overall2-year local failure-free survival, regional failure-free survival, distant failure-free survival, and overall survival rate was74.5%,88.0%,66.6%and42.5%, respectively. Twenty-eight patients had developed treatment failure. Of the28patients,14,5, and18had developed local failure, regional failure, and distant metastasis, respectively. All of the14local failures were considered in-field failures. Of the5regional failures,3were considered in-field failures and2were marginal failures. The most frequently observed acute toxicity was mainly Grade1or Grade2. The incidence of acute Grade3mucositis(including pharyngitis), skin reaction, and leukopenia was4.7%,12.5%and10.9%, respectively.Conclusions:IMRT for patients with CESCC was well tolerated and accomplished a satisfactory locoregional control. Distant metastasis was the predominate pattern of failure and the predominate pattern of locoregional failures was in-field failure.