The Long-term Survival Prognostic Influence Factors Of Prophylactic Postoperative Radiotherapy For Esophageal Cancer And Its Failure Mode Analysis

Objective:The aim of this study is that provide the best treatment modality of the prophylactic irradiation for esophageal cancer after radical resection by explore the clinical significance of prophylactic irradiation after resection of esophageal cancer, the long-term survival influencing factors and its failure mode.Methods:From January2003to December2008,100cases of esophageal carcinoma received radiotherapy after radical resection in the Department of radiotherapy the fourth hospital of Hebei Medical University were accord with the condition of entering the group were analyzed retrospectively. With the affecting factors of long-term survival in patients with Univariate and Multivariate statisties analysis, and analysis the failure reason after postoperative radiotherapy are described in details. Establish database and statistical analysis was performed by SPSS19statistical software.Results:The1,3,5-year survival rates were85.0%,54.0%and49.0%respectively,1,3,5-year local control rates were81.6%,68.6%and65.6%respectively,1,3,5-year metastasis free of survival rates were75.0%,51.0%and44.8%respectively,1,3,5-year disease free of survival rates were69.0%,49.7%and44.5%respectively. According to Univariate analysis, the results showed:1,T stage was the significant prognosis factors,specialy for the≤60years old patients.2, survival rates of patients without lymph node metastasis were better than those of patients with lymph node metastasis.3, when the number of lymph nodes metastasis increased, the survival rate was reduced, in turn N0, N1stage patients prognosis was good relatively N2, N3stage.4, Earlier TNM stage means better prognosis of survival rates.5, the prognosis of patients with time interval of31-60days between surgery and radiotherapy was better.6,patients received prophylactic radiotherapy of Dose of50-50.4Gy had better prognosis.According to Multivariate analysis, the age of patients, T stage and N stage were independent prognostic factors for overall survival of patients, the time interval between surgery and radiotherapy, radiotherapy dose were independent factors for local control, the age of patients, N stage were independent factors for survival without distant metastasis, the age of patients, T stage, N stage and radiotherapy dose were independent factors for disease free survival. Side effects during treatment included gastrointestinal, respiratory symptom and hematology toxicity etc.. The incidences of gastrointestinal and hematology adverse reaction were55.0%(55/100) and51.0%(51/100).There were19patients with acute radiation pneumonitis, and7patients with late radioactive lung injury. For all patients,there were18cases (18.0%) developing local recurrence,20cases (20.0%) developing distant metastases,and13cases (13.0%) developing both local recurrence and distant metastasis.There were52patients died, including17cases due to simple local recurrence,17cases due to simple distant metastasis, and12patients due to both local recurrence and distant metastasis. In51failure patients after treatment analysis showed that the time interval between surgery and radiotherapy, N stage were the effective factors on recurrence and the time interval between surgery and radiotherapy, N stage and TNM stage were the influencing factors of distant metastasis receiving postoperative in patients radiotherapy.According to Multivariate analysis, the time interval between surgery and radiotherapy, radiotherapy dose were independent factors of recurrence and the age of patients, N stage were independent factors of distant metastasis in patients receiving postoperative radiotherapy.Conclusion:1. T, N and TNM stages were important prognostic factors in patients with esophageal carcinoma.The earlier the stage, the better the prognosis.2. Patients receiving prophylactic irradiation in31～60days after surgery had better prognosis.3. Patients receiving radiotherapy dose from50to50.4Gy had batter prognosis.4. The main treatment failure modes of radiotherapy in patients after resection of esophageal cancer were still recurrence or/and metastasis. The time interval between surgery and radiotherapy, radiotherapy dose were independent factors of recurrence and the age of patients and N stage were independent factors of metastasis in patients receiving postoperative radiotherapy.