The Clinical Study Of Esophageal Carcinoma Treated By Three-dimensional Conformal Radiotherapy With Different Clinical Target Volume

Objective:The aim of this study is that determine the appropriate irradiation targe volumes and elective prophylactic irradiation necessary or not by to evaluate local control, survival, toxicity, and the first sites of failure of the esophageal carcinoma after three-dimensional conformal radiotherapy(3D-CRT).Methods and materials:From Jan.2005to Dec.2010,219patients of esophageal carcinoma without distant metastases were undertaken.The median age was67years(range40-89years). There were144males and75females. Two hundreds and six patients were squamous carcinoma,1patients was adenocarcinoma,12were undifferentiated carcinoma.Clinical staging for219cases esophageal carcinoma were:47patients with stage Ⅰ,50with stage Ⅱ and122with stage Ⅲ.Eighty-four patients were treated by sequential or concurrent chemo-radiotherapy, and other135patients received radiotherapy alone.All219patients were treated with3DCRT or intensity-modulated radiotherapy(IMRT). One hundred and five patients received54Gy-66Gy in27-33fractions with involved-field irradiation (IFI) that only including the primary tumor and positive lymph nodes.One hundred and fourteen patients received elective nodal prophylactic irradiation(ENI) which prescription dose of56Gy-70Gy in28-35fractions for primary lesion and46Gy-56Gy prescription dose was delivered to the cervical,periesophageal,mediastinal or perigastric lymph prevention area based on the primary lesion located sectional.Age, tumor site, hoarseness, T, N, TNM stage, tumor volume, irradiated dose, the sequential or concurrent chemotherapy were analyzed on local control rates,survival rates and non metastasis rate.Patterns of lymph node failure were classified according to the first sites of failure.For example in-field,regional and distant lymph node failures were defined as lymph node failures within the irradiated area, failures within the mediastinum or perigastric area beyond the irradiated area and outside the drainage regional lymph nodes,respectively.Results:A median follow-up time was23months and the following rate was96.35%. The complete response rate was30.1%(66/219) and the partial response rate was68.9%(151/219),the overall response rate was99.09%(217/219). The local control rate at1,3,and5years was66.94%,46.44%,and40.47%respectively.Median local control time for the total group of patients was28months.The overall survival rate at1,3,and5years was70.78%,35.64%,and20.74%,respectively.Median survival time for the total group of patients was23months.The overall non metastasis rate at1,3,and5years was79.93%,66.2%and55.04%,respectively.The result of univariate analysis showed that hoarseness, T stage and TNM stage were influencing prognosis factors. The Cox multivariate analysis showed that clinical T stage was an independent factor for the local control. Univariate analysis showed that hoarseness, T stage, N stage, TNM stage and the GTV volume were the important prognostic factor.The Cox multivariate analysis showed that TNM stage was independent factors for the overall survival.The1,3,and5years local control rates of IFI group and ENI group were62.97%,39.06%,27.20%and70.51%,53.34%,51.67%(x2=6.22,P=0.01).The1,3,and5years local contr-ol rates of IFI group and ENI group when patients years of <65were57.34%,28.91%,19.27%and69.31%,58.03%,54.81%(χ2=6.82,P=0.01).The1,3,and5years local control rates of IFI group and ENI with the patients of middle and lower-thoracic lesion were67.71%,37.71%,33.00%and73.50%,59.11%,59.11%(χ2=7.17,P=0.01).The1,3,and5years local control rates of the IFI group and ENI group with the patients of NO stage were69.49%,41.28%,18.35%and76.47%,58.26%,55.34%(χ2=5.94,P=0.01).The1,3,and5years local control rates of the IFI group and ENI group with the patients of without chemotherapy were65.43%,40.73%,17.46%and69.91%,53.61%,53.61%(χ2=3.94,P=0.04).The1,3,and5years survival rates of the IFI group and ENI group were67.62%,24.90%,15.00%and73.71%，45.06%,26.00%(χ2=5.04,P=0.03). The1,3,and5years survival rates of the IFI group and ENI with the patients of middle and lower-thoracic lesion were66.25%,23.02%,11.16%and70.49%,42.32%,30.20%(χ2=4.02,P=0.04).The1,3,and5years su-rvival rates of the IFI group and ENI group with the patients of N0were74.63%,29.72%,12.39%and80.65%,57.78%,29.72%(χ2=6.13,P=0.01).The ra-tes of irradiated esophagitis in the IFI group and ENI group were70.5%and82.5%(χ2=4.47,P=0.22) and the rates of pneumonitis were15.3%and19.3%(χ2=2.08,P=0.35).The complete response (CR),partial response(PR)and no res-ponse(NR)in IFI group and ENI group were19.0%,79.0%,1.9%and40.4%,59.6%,0.One hundred and forty patients exhibited treatment failure.Local fai-lure was observed in76patients,Local failure with recurrence in other sites was observed in31patients and distant metastasis in33patients.Conclusions:When esophageal carcinoma patients treated by3D-CRT or IMRI as the definitive aim, the elective nodal prophylactic irradiation was associated with improving the local control and survival.Furthermore,the patients with NO or middle and lower-thoracic lesion were more necessary received ENI irradiation.