IMRT-based preoperative neoadjuvant chemoradiotherapy for thoracic esophageal squamous cell carcinoma (ESCC)：an analysis of outcome and prognosis
10.3760/cma.j.issn.0253-3766.2016.09.009
- VernacularTitle:基于调强技术的术前同步放化疗联合手术治疗胸段食管鳞癌的疗效分析
- Author:
Yu MEN
1
;
Zhouguang HUI
;
Jun LIANG
;
Qinfu FENG
;
Dongfu CHEN
;
Hongxing ZHANG
;
Zefen XIAO
;
Zongmei ZHOU
;
Lühua WANG
Author Information
1. 100021,国家癌症中心 北京协和医学院中国医学科学院肿瘤医院放疗科
- Keywords:
Esophageal neoplasms;
Carcinoma,squamous cell;
Neoadjuvant chemoradiotherapy;
Surgery;
Prognosis;
Intensity modulated radiation therapy
- From:
Chinese Journal of Oncology
2016;38(9):682-686
- CountryChina
- Language:Chinese
-
Abstract:
Objective To analyze the outcome and prognostic factors of IMRT?based preoperative neoadjuvant chemoradiotherapy in patients with thoracic esophageal squamous cell carcinoma ( ESCC ) . Methods Clinical data of 62 patients with thoracic ESCC who received IMRT?based neoajuvant chemoradiotherapy from January 2009 to January 2015 were retrospectively analyzed. The radiation therapy was given 1.8?2 Gy/fraction per day over 5 days per week with 6 MV X?rays, and then all patients underwent esophagectomy and lymphadenectomy. Results Among the 62 patients, the R0 resection rate was 96.8%. Twenty ( 32. 3%) patients achieved pCR and 56 ( 90. 3%) cases got down?staging. Grade Ⅲ marrow suppression and esophagitis were seen in 8 (12.9%) and 2 (3.2%) patients, respectively. Eleven (17.7%) patients experienced postoperative complications and three died. The median follow?up was 27 months. The 1?, 3?and 5?year overall survival rates were 88.0%, 63.3% and 44.2%, respectively, with a corresponding disease?free survival rate of 68. 1%, 54. 8%, and 43. 9%, respectively. The univariate analysis showed that pre?treatment stage Ⅱ, down?staging, T/N pCR, good tumor response to neoadjuvant chemoradiotherapy, pN0 and R0 resection were favorable prognostic factors (P<0.05). The multivariate analyses indicated that pre?treatment stage was an independent prognostic factor. Conclusions For patients with thoracic ESCC, IMRT?based neoadjuvant chemoradiotherapy followed by surgery can achieve a higher R0 resection rate, down?staging rate, higher pCR rate, and a better tolerance. The incidence of postoperative complications is low. Pre?treatment stage, down?staging, pathological tumor response, lymph node status and R0 resection results are prognostic factors, and the pre?treatment stage is an independent prognostic factor.
