| Objective: To analysis the clinical results that compared simultaneous integrated boost with sequential boost to the lesion of esophageal,further explore the long-term efficacy of simultaneous integrated boost-intensity modulated radiation therapy(SIB-IMRT),including the specific results of complications and local-regional recurrence,to provide reference for SIB-IMRT in the treatment of esophageal cancer.Methods: From January 2006 to December 2015,330 patients diagnosed with esophageal cancer in our institution were respectively analysed according to our inclusion criteria.All patients received definitive radiotherapy with elective nodal prophylactic irradiation(ENI).Out of 330 patients,135 patients were treated with simultaneous integrated boost for dose escalation,and 195 patients were treated with sequential boost for dose escalation.The overall survival,loco-regional control,clinical efficacy and toxicity between the two groups were observed compared.The following variables prognosis factors were considered in univariate and multivariate analysis: age,gender,eating situation,tumor site,pathological type,length of esophageal barium meal,invasion of esophageal lesion,gross tumor volume,clinical T stage,clinical N stage,clinical TNM stage,chemotherapy and radiotherapy dose.Kaplan-Meier method was used for survival analysis,two independent samples t test was used for measurement datas and ?2 was used for count datas,P<0.05 were considered statistically significant.Results:1 The survival and all prognosis factors analysed: 98.5% of the patients were found upon follow-up to December 2016,with 5 of the patients lost.The 1-year,3-year,5-year overall survival rates of all patients were 80.9%,42.7%,26.3%,respectively.The 1-year,3-year,5-year locol control rates of all patients were 69%,39.8%,32.2%,respectively.The univariate analysis showed that the hoarse,eating situation,tumor length,the volume of GTV,structure and organs invaded by tumor,clinical T staging,clinical N staging,clinical TNM staging,chemotherapy were the influence factors of overall survival,the hoarse,eating situation,tumor length,the volume of GTV,structure and organs invaded by tumor,clinical T staging,clinical N staging,clinical TNM staging were the influence factors of local control.The multivariate analysis showed that the hoarse,the volume of GTV,clinical T staging,clinical N staging,chemotherapy,the way of radiotherapy were the independent of influence factors of overall survival,the hoarse,the volume of GTV,clinical T staging,clinical N staging,were the independent of influence factors of local control,2 Comparsion of the two groups: The 135 patients who received definitive radiotherapy with simultaneous integrated boost were compared with the 195 patients with sequential boost in terms of OS and LC.The LC rates and OS rates in the two groups showed statistically significant difference(P=0.014,0.050).Comparsion of OS and LC of the two groups of layers analysed indicated that with esophageal lesion length>5cm,OS showed statistically significant difference(?2=4.406,P=0.036),when lesion located in cervical esophageal or upper thoracic esophageal,LC showed statistically significant difference(?2=4.518,P=0.034),when the volume of GTV>35mm3,OS showed statistically significant difference(?2=5.364,P=0.021),at the clinical stage T3+4,OS showed statistically significant difference(?2=6.323,P=0.012),at the clinical stage N1+2,OS and LC of the two groups all showed statistically significant difference(?2=6.985,P=0.008 and ?2=5.152,P=0.023),at the clinical stage?+?,OS and LC of the two groups all show statistically significant difference(?2=6.830,P=0.009 and ?2=4.363,P=0.037),according to median partition prescribed dose of radiotherapy,at dose of radiotherapy?61.8Gy,the OS and LC of the two groups all showed statistically significant difference(?2=8.013,P=0.005 and ?2=4.890,P=0.027),3 In order to eliminate the error to make the results more raliable,two sets of clinical data of patients with propensity score matching(PSM)were then analysed further and compared.The 105 patients who received definitive radiotherapy with simultaneous integrated boost were compared with the 105 patients with sequential boost in terms of OS and LC.The LC rates and OS rates in the two groups didn't show any statistically significant difference.Further stratified analysis,only when chemotherapy was not used,OS showed nearly statistically significant difference(?2=3.609,P=0.057),LC showed statistically significant difference(?2=5.570,P=0.018),when the dose of radiotherapy>63Gy,OS showed statistically significant difference(?2=4.209,P=0.040),LC didn't showed statistically significant difference,4 Comparsion the occurrence rate of ? 2 grades Esophagitis and Pneumonia showed no statistically significant difference between patients receiving definitive radiotherapy with SIB-IMRT and those receiving sequential boost.However,lung Dmean,lung V5,lung V10,heart Dmean,heart V25,heart V30,heart V40,heart V45,heart V50 showed statistically significant differences between the two groups(P=0.003,0.000,0.000,0.017,0.005,0.000,0.000,0.000,0.000),5 The dose volume histogram analysis showed significant reduction in loco-regional recurrence rates when the CTV1D98,CTV1D95,PTV1D95 received relatively higher dose over time(P=0.033,0.046,0.035).On the other hand,when CTV1D98,CTV1D95,PTV1D95 received relatively higher dose,esophageal local recurrence rate was significantly lower(P=0.036,0.037,0.035).When CTV1V50?99% or PTV1V50?98%,esophageal local recurrence rate was low and close to statistical significance(P=0.065,0.064),meanwhile when PTV1V45?99%,esophageal local recurrence rate was significantly low(P=0.039).Conclusions:1 clinical T staging,clinical N staging,the volume of GTV,the hoarse were the independent of influence factors of overall survival and local control,in addition,chemotherapy and the way of radiotherapy were the independent of influence factors of local control,after propensity score matching(PSM),comparison of two the group didn't showed difference.2 SIB-IMRT can better protect the normal tissue and organs such as heart,lung.3 The target volume for higher doses,may reduce local recurrence or esophageal lesions in local recurrence,so as to improve local control rate. |
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