Effect Of Radiotherapy Dose On Cervical Esophageal Squamous Cell Carcinoma And Related Prognosic Factors Analysis

Objective To investigate the effect of radiotherapy dose on cervical esophageal squamous cell carcinoma,and to analyze the prognostic factors of cervical esophageal carcinoma.Method A retrospective analysis was performed on 96 patients with cervical esophageal squamous cell carcinoma who received 3D-RT or IMRT radiotherapy from 2013 to2018 according to inclusion criteria.All the patients are divided into three groups according to the dose of target(DT)as follows: low-dose group(DT≤60Gy),medium-dose group(60Gy<DT<66Gy)and the high-dose group(DT≥66Gy)respectively.The row × list data chi-square test was used for the comparison between the three groups.Bonferroni method was used to correct the p-value for the pairwise comparison of the inter-group rate.P<0.017 was considered to be statistically significant.Kaplan-Meier method was used to calculate overall survival(OS),loco-regional failure-free survival(LRFFS)and progression-free survival(PFS).Log-rank method was used to test differences and univariate analysis.Cox model was used to analyze prognostic factors.Results The follow-up was conducted to the end of October 2020,with a median follow-up time of 61 months and a median survival time of 28 months.The 1,3 and 5 year 0S were72.9%,37.9%,33.1%,LRFFS were 69.7%,43.8%,37.8%,PFS were 67.7%,36.4%,27.7% respectively of 96 patients.The short-term efficacy was observed with one month after radiotherapy,and the effective rate of the three groups was 66.7%,85.4%,and 85.7% respectively.There was no statistical difference in the short-term efficacy between the three groups(P=0.114).The 1,3 and 5-year OS of low,medium and high-dose groups were59.3%,23.1%,11.5%;75%,41.6%,41.6% and 85.7%,42.9%,32.7% respectively(P=0.031);LRFFS were 55.6%,13.7%,13.7%;74.8%,50.8%,43.1% and 81%,51.3%,44% respectively(P=0.02);PFS were 48.1%,12.3%,12.3%;72.9%,42.1%,31.4% and81%,42.9%,30.6%,(P=0.045)respectively.Subgroup analysis showed that there was no difference in the efficacy between the middle and high dose groups(all P>0.05),and all of them better than the low dose groups(all P<0.05).The occurrence of radioactive esophagitis was statistically different among the three groups(P=0.003),and the incidence of 3-4 grade radioactive esophagitis was higher in the high-dose group than in the middle-dose group(P < 0.017).There were significant differences in local regional recurrence among the three groups(P =0.037).There was statistical significance in the low-dose and medium-dose groups(P <0.017),and there was no significant difference between the middle and high dose groups(P=0.268).The independent prognostic factors of overall survival for cervical esophageal squamous carcinoma are radiotherapy dose,synchronous chemotherapy and invasion of adjacent organs.Conclusion1.Radical chemoradiotherapy is effective for cervical esophageal squamous cancer.2.The dose of target of 60Gy<DT<66Gy may be a more reasonable radiotherapy dose for cervical esophageal squamous cell carcinoma.3.Radiotherapy dose,concurrent chemotherapy and invasion of adjacent organs are independent prognostic factors of overall survival for cervical esophageal squamous cancer.