| Objective:The purpose of this study was to retrospectively analyze the clinical data of 61 patients with locoregional recurrence of esophageal squamous cell carcinoma who underwent re-irradiation after radical radiotherapy,to explore the optimal dose of re-irradiation for local recurrent esophageal cancer,to observe the efficacy,toxicity and 1-year,2-year and3-year survival rates after re-irradiation for local recurrence of esophageal cancer,and to explore the prognostic factors of re-irradiation for locally recurrent esophageal cancer.Methods:The clinical data of 61 patients with local recurrence of esophageal squamous cell carcinoma treated with re-irradiation from January2012 to December 2015 in Nanchong Central Hospital were collected,including age,sex,physical condition,recurrence pattern,length of recurrence tumor,clinical T stage,clinical N stage,re-irradiation dose and method,interval time between two radiotherapy,whether combined with chemotherapy,concurrent or sequential chemoradiotherapy,whether platinum-containing chemotherapy,single or double-drug chemotherapy,short-term efficacy,etc.All patients were treated with 6-MV linear accelerators for re-irradiation with 1.8–2.2Gy/fraction and 5fractions/week.Intensity-modulated radiotherapy and conformal three-dimensional radiotherapy were employed for re-irradiation.All patients were divided into low-dose group(50Gy?-?54Gy)and high-dose group(54Gy<-?60Gy)according to different radiation doses.All patients were followed up by telephone,inquiry of outpatient consultation or inpatient case information.The final follow-up date was December 30,2018.The main outcome measures include 1-,2-,3-year survival rates,short-term efficacy,toxicity.The relationship between clinical data and prognosis was analyzed.The database was established by statistical software SPSS 23.0.The survival rate was calculated by Kaplan-Meier method,the difference of survival curve was calculated by log-rank method,and single factor analysis was carried out.Cox model was used for multifactor analysis,and nonparametric chi-square test was used for counting data.Setting P<0.05 as statistical significance.Results:61 patients completed radiotherapy as planned.The follow-up rate was 100%.There were 30 cases in low dose group and 31 cases in high dose group.The response rate was 70.0%(21/30)in the low dose group and90.3%(28/31)in the high dose group.The difference was statistically significant(?~2=3.985,P<0.05).The 1-,2-and 3-year survival rates in the low dose group were 43.3%(13/30),26.7%(8/30),10.0%(3/30),and the median survival time was 9 months.The 1-,2-and 3-year survival rates in the high dose group were 67.7%(21/31),41.9%(13/31),16.1%(5/31).The median survival time was 16 months.The difference was statistically significant(?~2=4.282,P<0.05).The incidence of radiation esophagitis,bone marrow suppression,upper gastrointestinal tract reaction,radiation pneumonia,dermatitis and tracheitis were 50.0%(15/30),43.3%(13/30),33.3%(10/30),10%(3/30),3.3%(1/30)and 3.3%(1/30)respectively in the low dose group.The incidence of radiation esophagitis,bone marrow depression,upper gastrointestinal tract reaction,radiation pneumonia,dermatitis and tracheitis were 83.9%(26/31),51.6%(16/31),54.8%(17/31),12.9%(4/31),3.2%(1/31)and 3.2%(1/31)respectively in the high dose group.There was no significant difference in the incidence of toxicity between the two groups(P>0.05).Except for bone marrow depression,there were no toxicity greater than or equal to grade 3.The incidence of esophageal perforation in the low-dose group was 3.3%(1/30),the incidence of esophageal fistula was 3.3%(1/30),and the incidence of esophageal fistula in the high-dose group was 3.2%(1/31).Univariate analysis showed that age,physical condition,recurrence pattern,clinical N stage,dose of re-irradiation and short-term efficacy were the factors influencing prognosis and survival(P<0.05).Cox multivariate analysis showed that age,clinical N stage and short-term efficacy were independent factors influencing survival and prognosis of patients(P<0.05).Conclusion:Once esophageal cancer recurs after radical radiotherapy,the survival prognosis is poor,especially those with lymph node recurrence.Re-irradiation can improve the survival time of locally recurrent esophageal cancer.A higher dose of re-irradiation(50Gy?-?54Gy)can achieve better response rate and survival,and toxicities were tolerable.For those who are younger,have fewer metastatic lymph nodes and have better response rate(CR or PR)after re-irradiotherapy,the effect of radiotherapy on increasing survival benefit is more obvious. |
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