| Objective: To observe the short-term curative effect,toxic side effects and survival of postoperative recurrence of esophageal carcinoma treated with salvage chemoradiotherapy,and to analyze the effects of clinical factors,hematological different nutritional indexes and inflammatory indexes on survival,and to explore the predictive factors of treatment-related toxic and side effects.Materials/Methods: A total of 242 postoperative esophageal carcinoma patients with local/regional recurrence during January 2008 to December 2016 treated with chemoradiotherapy were analyzed.Recurrence included anastomotic recurrence and regional lymph node metastasis(supraclavicular,mediastinal and abdominal lymph node metastasis involved).The median age was 59 years(39~75),198 cases(81.8%)were male and 44 cases(18.2%)were female.25 cases(10.4%)were located in the upper thoracic segment,169 cases(69.8%)in the middle thoracic segment and 48 cases(19.8%)in the lower thoracic segment.According to the TNM staging criteria for thoracic esophageal carcinoma in the eighth edition of AJCC/UICC,there were 30 cases(12.4%)in stage Ⅰ,97 cases(40.1%)in stage Ⅱ,104 cases(43.0%)in stage Ⅲ and 11 cases(4.5%)in stage Ⅳ.All patients were treated with three-dimensional conformal or intensity modulated radiation therapy,and some patients with supraclavicular lymph node metastasis were treated with local dose of electronic line.The median prescription dose of GTV was 45 ~72 Gy.51 cases(21.1%)were irradiated by involved field,124 cases(51.2%)were irradiated by selective lymphatic drainage area,and 67 cases(27.7%)were irradiated by double supraclavicular area combined with mediastinal irradiation field(T-field).All the patients received synchronous or sequential chemotherapy,including 138 cases(57.0%)treated with synchronous chemotherapy and 104 cases(43.0%)treated with sequential chemotherapy.FP regimen was used in 116 cases,TP regimen in 108 cases,Tegafur in 7 cases,EP regimen in 5 cases and other regimens in 6 cases.A total of 151 patients with chemotherapy cycles less than 4 cycles,and 91 patients with chemotherapy cycle more than 4 cycles.The curative effect,toxic and side effects and 1,2,3 and 5 years survival of the patients were observed.The clinical features(sex,age,tumor location,regional recurrence site,number of recurrence areas,postoperative recurrence time),chemoradiotherapy related factors(post-recurrence treatment,radiotherapy target area,radiotherapy dose,chemotherapy regimen,chemotherapy cycle),hematological inflammation related indicators,including the absolute monocyte count(AMC),neutrophil lymphocyte ratio(NLR),platelet lymphocyte ratio(PLR),lymphocyte monocyte ratio(LMR),systemic immune-inflammation index(SII),systemic inflammation score(SIS),and hematological nutrition-related indicators,including total lymphocyte count(TLC),hemoglobin(HB),albumin(ALB),prognostic nutritional index(PNI),body mass index(BMI)on survival,toxic and side effects were analyzed.Results:1.Short-term efficacy: Among the patients with salvage chemoradiotherapy,42 cases(17.4%)reached CR,151 cases(62.4%)reached PR,42 cases(17.4%)reached SD,and 7 patients(2.9%)reached PD.The objective remission rate(CR+PR)was 79.7% and the disease control rate(CR+PR+SD)was 97.1%.2.There were significant differences in single-region recurrence between AMC group and LMR group(p=0.006;P=0.027).There was significant difference in tumor location between TLC group(P=0.000).There were significant differences in N stage,single regional recurrence and postoperative recurrence time between the patients with the lowest TLC during radiotherapy and chemotherapy(P=0.027;P=0.002;P=0.009).There were significant differences in sex among SIS group,ALB group and PNI group(P=0.025;P=0.018;P=0.009).There was no significant difference in baseline clinical features among PLR group,NLR group,HB group and SII group.3.Survival: The median survival time was 16.6 months,and the 1-,2-,3-and 5-year survival rates were 65.6%,36.7%,25.5% and 11.5%,respectively.Univariate analysis showed that chemotherapy cycle,NLR level,PLR level,LMR level,SII level,SIS level,HB level,PNI level before chemoradiotherapy and the minimum level of TLC during chemoradiotherapy were the influencing factors of OS.Multivariate analysis showed that the minimum level of TLC during chemoradiotherapy,chemotherapy cycle and ALB level before chemoradiotherapy were independent influencing factors of OS(P=0.006;P=0.002;P=0.005,respectively).4.There were 201 cases(83.1%)with acute hematological toxicity in the whole group,including 97 cases(40.1%)with grade 2 and 43 cases(17.7%)with grade 3 or more.There were 88 cases(36.4%)with acute radiation esophagitis,including 31 cases(12.8%)with grade 2 and 15 cases(6.2%)with grade 3 or more.5.Risk factors for adverse effectsAmong the clinical indicators,the treatment method after recurrence was the factor affecting the occurrence of radioactive esophagitis/gastritis residuals,and there were no factors affecting radioactive pneumonia.No factors affecting radioactive esophagitis/gastritis residuals or radioactive pneumonia were found in the inflammatory indicators and nutrition-related indicators.Conclusion:1.The efficacy of salvage radiotherapy and chemotherapy after esophageal cancer surgery is positive,and the toxic and side effects are acceptable.2.There was no significant difference in the overall survival rate between the involved field irradiation,the selective lymphatic drainage area irradiation and the T-shaped field irradiation.It is recommended to carry out the involved field irradiation for the patients with local/regional recurrence of thoracic esophageal squamous cell carcinoma after surgery.3.The radiotherapy dose increased to 60 Gy,which did not increase the curative effect of the patients.Concurrent chemoradiotherapy and sequential chemoradiotherapy were both feasible treatment modes,while TP and FP were both feasible chemotherapy schemes.4.Patients in the low NLR group,the low PLR group,the high LMR group,the low SII group,the low SIS group,the non-anemic group,the high PNI group,and the low TLC g0-3 group during the chemoradiotherapy had a high survival rate.5.The treatment method after recurrence is the factor affecting the occurrence of radioactive esophagitis/gastritis residues.No factors affecting radioactive esophagitis/gastritis residues or radioactive pneumonia are found in the inflammatory index and nutritional index of hematology.6.Chemotherapy cycle,TLC minimum level and ALB level during radiotherapy and chemotherapy are independent influencing factors for the total survival of patients with esophageal cancer after multiple release of salvage radiotherapy and chemotherapy. |
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