Open AccessDefinite intensity‐modulated radiotherapy with concurrent chemotherapy more than 4 cycles improved survival for patients with locally‐advanced or inoperable esophageal squamous cell carcinoma
Author(s) -
Hsieh HeYuan,
Hsu ChungPing,
Yeh HuiLing,
Chuang ChengYen,
Lin JaiFu,
Chang ChenFa
Publication year - 2018
Publication title -
the kaohsiung journal of medical sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.439
H-Index - 36
eISSN - 2410-8650
pISSN - 1607-551X
DOI - 10.1016/j.kjms.2017.12.005
Subject(s) - medicine , chemotherapy , radiation therapy , oncology , stage (stratigraphy) , esophageal cancer , esophageal squamous cell carcinoma , survival rate , carcinoma , cancer , gastroenterology , paleontology , biology
We investigated which prognostic factor could improve survival for esophageal cancer patients who received definite concurrent chemoradiation (CCRT). Eighty patients with age ≥18, Karnofsky Performance Scale (KPS) ≥ 60, and clinical stage T1‐4N0‐3M0 esophageal squamous cell carcinoma were enrolled from July 2004 to December 2015. They underwent definite intensity‐modulated radiotherapy (IMRT) with or without simultaneous integrated boost to the primary tumor, and reception of concurrent chemotherapy ≥ 1 cycle. The primary endpoints were overall survival (OS), locoregional progression‐free survival (LRPFS) and distant metastasis‐free survival (DMFS). The median follow‐up duration for alive patients was 21.5 months. The rates of 2‐, 3‐ and 5‐year OS/LRPFS/DMFS were 23.8%/53.5%/49.3%, 19.1%/44.6%/49.3%, and 13.0%/44.6%/43.9%, respectively. Only the non‐clinical complete response (non‐cCR) after CCRT was an independent poor prognostic factor in OS (HR 3.101, 95% CI 1.535–6.265, p = 0.0016). Radiation dose >50.4 Gy and chemotherapy ≥4 cycles significantly predicted better LRPFS ( p = 0.0361 and 0.0163, respectively). Poorly differentiated tumor and stage III disease have poor DMFS ( p = 0.0336 and 0.0411, respectively), and chemotherapy ≥ 4 cycles was a better predictor ( p = 0.0004). In subgroup analysis, patients who received radiation dose ≤50.4 Gy with concurrent chemotherapy ≥4 cycles had the best survival outcome with 1‐, 2‐, 3‐ and 5‐year survival rates of 73.7%, 39.4%, 31.5% and 17.5%, respectively. In conclusion, definite radiotherapy with concurrent chemotherapy ≥4 cycles improved the survival for patients with inoperable or locally‐advanced esophageal squamous cell carcinoma.