Observation Of Short-term Curative Effect In Treatment Of Upper Esophageal Cancer With Three Dimensional Conformal Radiotherapy

ObjectiveTo analyze and evaluate the short-term effect of radical surgery and three dimensional conformal radiotherapy(3D-CRT)to upper esophageal cancer retrospectively,then to choose reasonable treatment,to improve therapeutic effect and relieve side effort.ApproachesChoose 88 patients with upper esophageal cancer who received hospitalization in Affiliated Hospital of Taishan Medial University from December 1,2012 to December 1,2016 retrospectively and separate them into two groups according to different treatments.One group of 46 patients receive radical surgery and postoperative adjuvant treatment called surgery group and another group of 42 patients receive three dimensional conformal radiotherapy and adjuvant treatment called 3D-CRT group.The surgery group can receive any types of radical surgery according to the feature in each patient and receive adjuvant treatment 4 weeks after the surgery according to the specific condition,such as clinical stages and KPS,of each patient.The 3D-CRT group can receive radical intensity modulated radiation therapy and will be treated with synchronous or sequential chemotherapy 4 weeks later.Evaluate the curative effect after initial treatment in 6 months.In next 6 months,no in situ recurrence or no distant metastases can be regarded as effective.If recurrence can not be evaluated,complete and partial remission can be seen as effective.To compare the different types of recurrence and survival curves in two groups and to analyse the factors which may influence the recurrence time.To evaluate the side efforts,including bone marrow depression and radiation damage of pharynge and esophagus.All the data is calculated and analysed with SPSS20.0.The Chi-square test is used to compare the difference of effective rate in two treatments.The logistic regression is used to analyse the risk of recurrence in 6 months.The kaplan-Meier method,K-M curve and log-rank test are used to analyse the recurrence time in two groups.The cox proportional hazard regression model is used to evaluate the recurrence factors of two groups.It has statistical significance if P<0.05.Results1.The cure effective rate of surgery group in 6 months reaches 78.26%and 3D-CRT group gets 88.10%.The ~2x-test suggest statistical significance(~2x=1.502,P=0.042):3D-CRT group had a better curative effect.2.The logistic regression shows that 3D-CRT to primary tumor is a protective factor to prevent recurrence in 6 months.(P=0.019,Exp(B)=0.197).But clinical stages and surgery put no effort on recurrence in 6 months(P>0.05).3.The cox proportional hazard regression model shows that 3D-CRT and recurrence types have no relation with recurrence time(P>0.05).However,clinical stages have connection with recurrence time that the higher the stage is,the shorter the recurrence time(P=0.024,Exp(B)=0.206).The surgery group was easier to be distant metastasis and the 3D-CRT group is easier to be in situ recurrence.The ~2x-test suggest statistical significance(x~2=4.418,P=0.036).Survival analysis of two groups shows that recurrence proportion decreases(cumulative proportion increases)under the progress of time.The mean recurrence time of surgery group is 14.5 months and the median recurrence time is 9months while the mean recurrence time of 3D-CRT group is 15.1 months and the median recurrence time is 12 months.The Log Rank(Mantel-Cox)test value is 0.033,P value is0.857.The Breslow(Generalized Wilcoxon)test value is 0.135,P value is 0.713.The Tarone-Waret test value is 0.115,P value is 0.735.All the P values are greater than 0.05,no statistical significance is found.After two groups are combined,the mean recurrence time is 14.7 months and he median recurrence time is 10 months.4.In surgery group,40 subjects get no bone marrow depression while 4 and 2 subjects separately get rate?and rate?depression.In 3D-CRT group,34 subjects get no bone marrow depression while 6 and 2 subjects separately get rate?and rate?depression.No statistical significance is found(x~2=0.706,P=0.703).But,conspicuously,almost every patients in 3D-CRT group get radioactive injuries.There are 32 subjects reach rate?,9subjects reach rate?and 1 subjects falls rate?.Statistical significance is found(~2x=57.461,P<0.05).Moderate correlation exists between 3D-CRT and radioactive injuries(coefficient of contingency is 0.629 between 0.4 and 0.7,P<0.05).Conclusion1.Surgery and 3D-CRT have something to do with short-term(6 months)curative effect and recurrence rate of upper esophageal cancer:3D-CRT is better than surgery.2.3D-CRT to primary tumor is a protective factor to prevent recurrence in 6 months.It can prevent distant metastasis and primary recurrence effectively.But clinical stages and surgery put no effort on recurrence in 6 months.3.The higher the clinical stages are,the shorter the recurrence is.3D-CRT to primary and recurrence types have no relation with recurrence time.The surgery group was easier to be distant metastasis and the 3D-CRT group is easier to be in situ recurrence.No statistical significance is found in two groups.4.Intensive care should be put on patients who receive 3D-CRT in order to prevent radioactive injuries.