| Background and purpose:Esophageal cancer is one of the most malignant digestive tract tumors,with high morbidity and mortality and poor prognosis.Surgery is one of the main methods for the treatment of esophageal cancer,but in the elderly patients with esophageal cancer,due to the larger postoperative complications of the operation and the elderly patients’ own tolerance decreases with age,the radical concurrent chemoradiotherapy has become the standard treatment for patients who are unwilling or unable to operate.Currently,in the clinical treatment of elderly esophageal cancer,regular review is usually taken after concurrent chemoradiotherapy and corresponding treatment methods are developed as the disease progresses.The efficacy of adjuvant chemotherapy is still uncertain,and it remains to be observed whether the long-term efficacy can be controlled by further strengthening adjuvant chemotherapy under the condition that elderly patients can be tolerated.This study retrospectively analyzed141 elderly patients with esophageal squamous cell carcinoma(ESCC)in the radiotherapy department of the First Affiliated Hospital of Bengbu Medical College,aiming to investigate the clinical efficacy and adverse reactions of adjuvant chemotherapy with or without S-1 after radical concurrent chemoradiotherapy in elderly patients with ESCC,and to analyze the relevant prognostic factors.Methods:Clinical data of 141 elderly patients with esophageal squamous cell carcinoma(≥70 years old)were collected for this study from June 1,2016 to June 30,2019.All patients had previously received radical concurrent chemoradiotherapy in the radiotherapy department of the First Affiliated Hospital of Bengbu Medical College.The patients were divided into chemotherapy group and control group according to whether or not they received adjuvant chemotherapy,including 52 patients in the chemotherapy group and 89 patients in the control group.The clinical efficacy,toxic and side effects of the two groups were observed,and Kaplan-Meier statistical analysis was performed on T stage,adjuvant chemotherapy and the length of primary tumor.Results:The median follow-up time of the whole group was 28.4 months.The 2-year and 3-year OS of the chemotherapy group and the control group were 54.9%,46.1%and 44.8%,30.9%(P=0.096),the 2-year and 3-year PFS were 57.8%,49.6%,38.8%,28.1%(P=0.040),and the 2-year and 3-year LRFFS were 67.3%,62.5%,44.2%,35.6%(P=0.011),respectively.Single factor analysis showed that age < 76 years,and the length of the primary tumor < 6.5 cm,T stage for 2-3,no lymph node metastasis and clinical stage is Ⅱ ～ Ⅲ have better OS.T stage for 2-3,clinical stage Ⅱ ～ Ⅲ and adjuvant chemotherapy with S-1 are closely related to better PFS and LRFFS.Cox multivariate analysis showed that adjuvant chemotherapy brought higher PFS and LRFFS(both P < 0.05),but had no significant effect on OS.Clinical staging Ⅱ-Ⅲcompared with Ⅳ a period have better OS,PFS and LRFFS;Age less than 76 years and negative lymph nodes were associated with better clinical outcomes.The incidence of adverse reactions in both groups was low,mainly grade 0-1,and the incidence of adverse reactions in the adjuvant chemotherapy group was slightly higher than that in the control group,mainly including bone marrow suppression and gastrointestinal adverse reactions,etc.,with little difference(P>0.05).There were no treatment-related deaths in either group.Conclusion:For elderly patients with esophageal squamous cell carcinoma,adjuvant chemotherapy with S-1 after concurrent chemoradiotherapy can improve progression-free survival and region-free recurrence survival,and the incidence of related adverse reactions is low and tolerable.S-1 monotherapy can be used as an adjuvant chemotherapy treatment option for elderly patients with esophageal squamous cell carcinoma after radical concurrent chemoradiotherapy. |
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