| Background and PurposeEsophageal cancer is one of the top ten cancers in China,and the number of esophageal cancer patients in China accounts for 60% of the world.A large part of esophageal cancer patients have been found in the middle and late stage,missed the best treatment period.Synchronous chemoradiotherapy has become the standard treatment for unresectable locally advanced esophageal cancer,but local recurrence and distant metastasis are still the main causes of failure in the treatment of esophageal cancer.In this study,retrospective analysis was used to analyze the clinical efficacy of concurrent chemoradiotherapy and consolidation therapy after concurrent chemoradiotherapy,so as to explore whether locally advanced esophageal cancer patients need concurrent chemoradiotherapy after consolidation chemotherapy,and which chemotherapy regimen is the most suitable.Materials and MethodsThis study retrospectively analyzed 307 patients with esophageal squamous cell carcinoma who were newly diagnosed and met the admission and discharge criteria in Luohe Central Hospital from January 2010 to July 2015,including 195 males and 112 females,aged 40-78 years(median 58 years).Patients with and without consolidation chemotherapy were divided into two groups: one group receiving consolidation chemotherapy(CCRT+CCT)and one group without consolidation chemotherapy(CCRT alone).According to different chemotherapy regimens,the patients were divided into: fluorouracil + cisplatin group,paclitaxel + cisplatin group,paclitaxel +oxaliplatin group.Chi-square test was used to compare the short-term efficacy and acute adverse reactions among all groups.Kaplan-Meier method was used to draw the survival curve,and the differences of progression-free survival and overall survival among all groups were compared by Log-rank test.When P<0.05,the data difference was statistically significant.Results1.The total effective rates of CCRT alone and CCRT+CCT in the short-term efficacy were 84% and 89%,respectively,and the difference was not statistically significant(P > 0.05).2.In terms of acute toxic reactions,CCRT+CCT showed significant difference in leukopenia(P < 0.05).3.In terms of long-term survival benefit,the overall survival rates of CCRT alone and CCRT+CCT in 1,3 and 5 were 79.9%,36.0%,26.6%,and 84.5%,42.9%,36.3%,respectively,showing no statistically significant difference,but the 5-year survival rate of the consolidated chemotherapy group was higher than that of the unconsolidated chemotherapy group.The median overall survival time(MOS)was24.9 months and 27.1 months,respectively.The 1,3,and 5 progression-free survival rates of CCRT alone and CCRT+CCT were 58.9%,18.7%,11.5%,and 70.8%,31.5%,26.8%,respectively,and the median progression-free survival(MPFS)was 12.5months and 17.8 months,respectively.4.The total effective rates for the short-term efficacy of CCRT alone and CCRT+CCT in the fluorouracil + cisplatin group,paclitaxel + cisplatin group and paclitaxel + oxaliplatin group were:77.5%,78.6%,84.3%,92.3%,89.6%,95%,that is,there was no significant difference between CCRT alone and CCRT+CCT,but the effective rate of paclitaxel + oxaliplatin was significantly higher than that of fluorouracil + cisplatin and paclitaxel + cisplatin groups.5.The 1,3 and 5 year overall survival rates in the fluorouracil + cisplatin,paclitaxel + cisplatin and paclitaxel + oxaliplatin groups compared with CCRT+CCT were 67.5%,30%,25% and 82.1%,35.7%,28.6%,respectively:78.4%,33.3%,25.5% and 84.6%,46.1%,38.4%,91.6%,43.7%,33.3% and 96.6%,46.7%,41.6%;The difference of paclitaxel + cisplatin was significant in the other groups,but the effect of CCRT+CCT was better.There was no significant difference between the two groups,but the effect of paclitaxel + oxaliplatin group was better.Median overall survival(m OS)were 14.3 and 22.6,19.8 and 30.6,29.6 and 34.6(month),respectively.The 1,3,and 5 year progression-free survival rates in the fluorouracil +cisplatin,paclitaxel + cisplatin,and paclitaxel + oxaliplatin groups of CCRT alone and CCRT+CCT cohort were:52.2 %,15%,10% and 61.2%,23.2%,21.4%,58.8%,19.6%,11.8% and 69.2%,32.7%,26.9%,64.4%,20.83%,12.5% and 84.6%,38.3%,30%,Median progression-free survival(MPFS)12.3 and 14.3,12.5 and 17.8,16.8 and 23.8(in months);CCRT+CCT can prolong the progression-free survival(PFS).The differences between groups of fluorouracil + cisplatin group and paclitaxel +oxaliplatin group are significant,while the differences between other groups are not significant.6.There was no significant difference between CCRT alone and the fluorouracil+ cisplatin group,paclitaxel + cisplatin group and paclitaxel + oxaliplatin group in gastrointestinal reactions such as radiation esophagitis,radiation pneumonia,nausea and vomiting,abnormal liver function,and myeloid suppression(leukopenia,thrombocytopenia).However,the incidence of side effects was higher in consolidation chemotherapy group.There was no significant difference between groups,but the acute side effects were slightly higher in the fluorouracil group than in the other groups,while the oxaliplatin group had relatively lower side effects.Conclusion1.There was no significant different in short-term efficacy between the CCRT alone group and the CCRT+CCT group,and the overall survival rate of the CCRT+CCT group was slightly better than the CCRT alone group,but there was no significant advantage.2.In terms of acute toxic reactions,the CCRT+CCT group was slightly higher than the CCRT alone group,especially in the aspect of leukopenia.Radiation pneumonia and leukocytopenia were more serious in paclitaxel +cisplatin group during consolidation chemotherapy.3.Consolidation chemotherapy after concurrent chemoradiotherapy does have certain advantages in controlling tumor recurrence and metastasis,especially in prolonging progression-free survival of patients.In terms of complementary chemotherapy regimens,the different chemotherapy regimens presented similar results,but patients in the paclitaxel + oxaliplatin group had significantly longer survival. |
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