Treatment Result Of Concurrent Chemoradiotherapy For Patients With Tracheoesophageal Groove Lymph Node Metastasis From Esophageal Cancer

Background:Esophageal Cancer is the eighth most common cancer in the world,and it is endemic in many regions of the world. There is still high incidence rate and death rate of Esophageal Carcinoma in China. High prevalence area in China is mainly located in region of Taihang Mountain among Henan Province, Hebei Province and Shanxi Province such as Lin County in Henan, Ci County in Hebei and Yangcheng in Shanxi. However tracheoesophageal groove lymph node metastasis of Esophageal Cancer patients means a poor prognosis. Meanwhile, it will influence their quality of life. This research analyzes patients of tracheoesophageal groove lymph node metastasis retrospectively, and evaluate efficacy of concurrent chemoradiation therapy to control metastasis of tracheoesophageal groove lymph node, so as to prolong patients’life time and improve quality of life.Objective:Analyze short-term therapeutic effect and negative effect of concurrent chemoradiation therapy for patients with tracheoesophageal groove lymph node metastasis from esophageal cancerMethods:Retrospectively analyzed40patients of squamous esophageal cancer with trocheoesophageal groove lymph node metastasis in Cancer Research and Therapy Center of Shandong Provincial Hospital from June2009to January2013. Patients with surgical contraindications and those who refused to undergo surgery were enrolled.Patients with or without clinical manifestation such as hoarseness, cough when drinking and swallow obstruction are eligible. Tracheoesophageal groove lymph node metastasis is diagnosed by CT scan.According to the difference of treatment,40patients are divided into treatment arm with17patients and control arm with23patients. After CT scan, CT simulation, target volume delineation and treatment planning, treatment arm received three-dimension conformal radiotherapy and concurrent chemotherapy with one cycle of PF regimen(Cisplatin25mg/m2day1-3+Fluorouracil500mg/m2day1-5). While control arm only received radiotherapy. At last, assess and compare remission of clinical manifestation, short-term therapeutic effect and negative effect between two armsResult:All of the40patients completed therapy.(1)Remission of clinical mani-festation:The clinical symptoms like hoarseness,cough when drinking and swallow obstruction in both arms relieved significantly. In treatment arm, remission rate of hoarseness, cough when drinking and swallow obstruction is85.7%,100%and83.3%respectively. While in control arm, remission rate of these above-mentioned clinical symptoms is77.8%,87.5%and81.8%respectively.(2)The case of complete remission plus partial remission of treatment arm and control arm is13and14respectively, the overall response rate of treatment arm and control arm is76.5%and60.9%respectively(P>0.05).(3)Side effect of radiation therapy and chemotherapy:In treatment arm, the case of grade Ⅰ-Ⅱ radiation esophagitis, grade Ⅲ-Ⅳ radiation esophagitis, grade Ⅰ-Ⅱ radiation tracheitis, grade Ⅲ-Ⅳ radiation tracheitis was2,0,6and1separately.There was2,4,3and2cases respectively of grade Ⅰ-Ⅱ arrest of bone marrow, grade Ⅲ-Ⅳ arrest of bone marrow,grade Ⅰ-Ⅱ digestive reaction, grade Ⅲ-Ⅳ digestive reaction in treatment arm. Comparatively, the number of grade Ⅰ-Ⅱ radiation esophagitis, grade Ⅲ-Ⅳ radiation esophagitis, grade Ⅰ-Ⅱ radiation tracheitis, grade Ⅲ-Ⅳ radiation tracheitis is7,1,5and3respectively in con-trol arm. There were2cases of grade Ⅰ-Ⅱ arrest of bone marrow in control arm. And no case occurred grade III-IV arrest of bone marrow and digestive reaction in control arm. Conclusion:When compared with radiation therapy, concurrent chemotherapy with PF regimen has the tendency to improve the short-term therapeutic effect of esophageal cancer patients with tracheoesophageal groove lymph node metastasis. Meanwhile, negative effect of concurrent chemoradiation therapy is also tolerable to patients of esophageal cancer.