| Objective:This study retrospectively analyzed the efficacy and safety of different dose modes of adjuvant radiotherapy after endoscopic submucosal dissection(ESD)for early esophageal carcinoma,providing a basis for the formulation and optimization of radiotherapy plans.Methods:From December 2016 to June 2022,41 patients admitted to the First Affiliated Hospital of Anhui Medical University with esophageal carcinoma undergoing adjuvant radiotherapy after ESD were retrospectively analyzed,confirmed by paraffin pathology,with postoperative pathological stages of T1 a or T1 b and lymphovascular infiltration(Lymphovascular Invasion(LVI)was positive or negative,all patients were treated with intensity-modulated radiotherapy technique,and were divided into observation group(prescription dose <50Gy)and control group(prescription dose≥50Gy)according to the different radiotherapy dose patterns received by the patients,with 22 cases in the observation group and 19 cases in the control group.Statistical and data analysis was performed using the SPSS24.0 software package,a product of IBM.p < 0.05 was defined as statistically significant.The patients in the observation and control groups were compared in terms of acute phase toxic side effects and severity during adjuvant radiotherapy,esophageal stricture,swallowing function and diet of patients after radiotherapy,local area control,causes of death and treatment pattern of failure in patients with metastatic recurrence in both groups,and overall survival time(Overall Survival,OS),disease-free survival time(Disease-Free Survival,DFS),and single-factor survival analysis were performed.Results:1.The common side effects in the observation and control groups were hematologic toxicity,radiation pneumonia,and radiation esophagitis,etc.The incidence of radiation esophagitis grade 1-2 and grade 3 in the observation group was significantly lower than that in the control group(P<0.05),while the incidence of acute hematologic toxicity and radiation pneumonia in the observation and control groups were different,but the difference was not statistically significant(P>0.05).By the time of the last follow-up,33 patients(86.8%)were on a normal diet,2patients(5.3%)required a soft diet,1 patient(2.6%)required a semi-liquid diet,and 2 patients(5.3%)required a liquid diet.Of the seven patients diagnosed with esophageal stricture before adjuvant radiotherapy,six patients were on a normal diet by the time of the last follow-up,and one patient required a semiliquid diet after multiple balloon dilatation.2.The local control rate was 95.1% and the regional control rate was 97.6% in the whole group of 41 patients.3 patients(7.3%)had recurrence and metastasis,of which 2 patients(4.8%)had local recurrence and 1 patient(2.4%)had regional lymph node recurrence combined with distant metastasis,the distant metastasis site was the hilar region and the mucosa of the gastric wall,the site of regional lymph node recurrence was the left lymph node of the stomach,3 patients All three patients had recurrent metastases within the radiation field.The overall recurrence rate was 4.8%(1/22)vs.10.5%(2/19)in the observation group and control group,respectively,with no statistically significant difference(P=0.895);the local recurrence rate was 4.8%(1/22)vs.5.3%(1/19)in the observation group and control group,respectively,with no statistically significant difference(P=1.000);The regional recurrence rate was 0%(0/22)vs.5.3%(1/19)in the observation and control groups,respectively,with no statistically significant difference(P=0.941);the distant metastasis rate was 0%(0/22)vs.10.5%(1/19)in the observation and control groups,respectively,with no statistically significant difference(P=0.941).3.The median overall survival time was not achieved in both the observation and control groups,and the overall survival rates at 1,2,and 3 years were 100%,100%,87.5%,and 100%,93.3%,93.3% in the observation and control groups,respectively,and the differences were not statistically significant when the above data were further tested by Log-rank test(P=0.985).The median disease-free survival time was not achieved in the observation and control groups,and the 1-,2-,and 3-year disease-free survival rates were 100%,93.8%,93.8%,and89.5%,89.5%,and 89.5% in the observation and control groups,respectively,and there was no significant difference in the disease-free survival time between the observation and control groups when the above data were subjected to Log-rank test(P=0.473).No independent prognostic factors for overall survival time and disease-free survival time were found by performing univariate analysis.Conclusion:1.Higher radiotherapy dose modalities(prescription dose≥50Gy)were more prone to grade 1-2 acute radiation esophagitis as well as grade 3 acute radiation esophagitis;the incidence of esophageal stricture was low and swallowing function was well preserved after ESD combined with adjuvant radiotherapy for early esophageal carcinoma2.The local regional situation was well controlled in the whole group,and there was no significant difference between the observation group and the control group in the overall recurrence rate,local recurrence rate,regional recurrence rate and distant metastasis rate;recurrent metastasis occurred mainly in the radiation field.3.The higher radiotherapy dose modality(prescription dose≥50Gy)in adjuvant radiotherapy after ESD for early esophageal carcinoma did not present better prognostic survival;univariate analysis did not find independent prognostic factors for overall survival time and disease-free survival time. |
PDF Full Text Request