Comparison Of Concurrent Chmoraidiotherapy Followed By Adjuvant Chemoradiotherapy Versus Concurrent Chemoradiotherapy Alone In Treatment Of Unrecectable Locoregionally Advanced Esophageal Squamous Cell Carcinoma

Objective:This retrospective study compared the effective,toxicity and the independent factors effect on prognosis of concurrent chemoradiotherapy plus adjuvant chemotherapy(CCRT+AC)compared to concurrent chemotherapy alone(CCRT)to patients with unresectable locally advancede esophageal squamous cell carcinoma.To evaluate the survival benefits between CCRT+AC and CCRT.We also analyzed the prognosis of patients according with 2010 clinical staging of esophageal carcinoma treated with non-surgical methods,investigate the predictive value and deficiency of the clinical staging.Methods:The cilical data of 102 patents who was diagnosed esophageal carcinoma by pathological department of our hospital were retrospectively analyzed.49 patients were given concurrent chemoradiotherapy plus adjuvant chemotherapy and 53 patients were given concurrent chemotherapy alone.Radiotherapy(three-dimensional conformal radiotherapy or intensity modulated radiation therapy)was administered in both arms.Prescription dose:6MV-X line,GTV60-67.5Gy/28-32 fractions,CTV50.4-57.6Gy/28-32 fractions.The regimens of concurrent chemotherapy or adjuvant chemotherapy included DDP 5-Fu(PF)and DDP paclitaxel(TP).Observed early and lately toxicity in both arms.And evaluated the short-term response rate and survival benefits.Results:Observationed the short-term response rate in the end of radiotherapy.The overall response rate(CR+PR)of CCRT+AC group was 91.8%,that of CCRT group was 88.7%,P=0.592.The l,2,3-year overall survival rates in patients with concurrent chemoradiotherapy plus adjuvant chemotherapy and concurrent chemotherapy alone were 87.6%.64.9%.44.1%和 76.8%、50.6%.30.6%,respectively[HR 1.493(95%CI:0.895-2.492),P=0.108].The 1,2,3-year loco-regional failure-free survivial rates(LFFS)with CCRT+AC group and CCRT group were 69.8%.51.3%,38.2%and 66.1%、43.9%、33.9%,respectively,no significanct difference was found in LFFS in both arms(P=0.317).The distant failure-free survivial rates(DFFS)at 1,2,3-year in CCRT+AC group(70.3%、56.8%、44.7%)and in the CCRT group(59.9%、35.1%.27.9%)showed a significant difference(P=0.045).The Ovgrall survival rates of the esophageal cancer patients with cervical and upper thoracic,middle and lower thoracic locations of tumor at 1,2,3-year in CCRT+AC group(86.2%,65.3%,42.6%)and in the CCRT group(75.9%,50.6%,28.8%)showed a signifcant difference(P=0.045).By univariate and multivariate analyses,T stage,shor-term response rate,distant failure-free survivial(DFFS)were independent factors predictive of better survival.According to the independent prognostic factors(T stage,shor-term response rate and DFFS),both arms were divided into high-risk and low-risk group.The median follow-up time with the high-risk and low-risk group in CCRT+AC were 26 months and 13.8 months,while 19 months and 13.4 months in CCRT group.Thus,the overall survival rates had been improved significantly in low-risk groups in CCRT+AC group compared with CCRT group(P=0.027).According to the non-surgical clinical staging for esophageal carcinoma,along with the increase of T stage,the survival rates of patients had a tendency to decrease,P=0.003.Along with the increase of N stage,the survival rates of patients had a tendency to decrease,the overall survival rates of NO staging was higher than N1 and N2 stage(P=0.028),but there was no difference in the overall survival rates between N1 and N2 stage(P=0.014,P=0.006).Lymph nodes were divided into non(NO)and lymph node metastasis(N+),the overall survival rates of NO andN N+ showed significant differences(P=0.007).The overall survival rates between II and III stage were statistically significant(P=0.043).Conclusion:Patients with unresectable locally advancede esophageal squamous cell carcinoma didn’t receive a significant survival benefit from addition of adjuvant chemotherapy to concurrent chemoradiotherapy.But the distant failure-free survivial rates were higher with patients who received adjuvant chemotherapy.Patients with earlier T stage,higher the short-term response rate and longer distant failure-free survivial may benefit from addition of adjuvant chemotherapy to concomitant chemoradiotherapy.The’ independent prognostic factors of the patients with esophageal carcinoma were T stage,shor-term treatment effect and distant failure-free survivial(DFFS).The protocol is applicable to T staging,but N staging cannot well reflect prognosis.It’s better to reflect prognosis to only classify the lymph nodes into NO and N+ stage.