Analysis of the clinical value of different radiotherapy schemes in patients with advanced esophageal squamous cell carcinoma

doi:10.3760/cma.j.cn371439-20200710-00092

Abstract

Abstract:

Objective To compare the clinical efficacy, adverse reactions and prognosis of different radiotherapy schemes in the treatment of advanced esophageal squamous cell carcinoma.Methods The clinical data of 60 patients with stage ⅣB esophageal squamous cell carcinoma who received radiotherapy in Rugao People's Hospital of Jiangsu Province from January 2015 to January 2020 were retrospectively analyzed. According to the radiation doses, the patients were divided into standard dose group (total radiation dose <50.4 Gy) and high dose group (total radiation dose ≥50.4 Gy), with 30 patients in each group. The scores of dysphagia before and after treatment were analyzed by Wilcoxon signed-rank test. The radiotherapy effective rate, remission rate of dysphagia and incidence of adverse reactions were analyzed by χ ² test. Survival analysis was carried out by Kaplan-Meier and log-rank test was used to compare the prognosis of the two groups. Results There were no significant differences in dysphagia scores between standard dose group and high dose group before and after radiotherapy (Z=1.232, P=0.876; Z=1.506, P=0.278). The dysphagia symptoms were relieved after radiotherapy in all patients, and the dysphagia score was significantly higher than that before radiotherapy (Z=6.347, P<0.001). The radiotherapy effective rates in the standard dose group and high dose group were 76.7% (23/30) and 83.3% (25/30) respectively, with no statistically significant difference (χ²=0.417, P=0.519). The remission rates of dysphagia in the two groups were 80.0% (24/30) and 90.0% (27/30) respectively, with no statistically significant difference (χ ²=0.523, P=0.470). The incidences of adverse reactions in the two groups were 43.3% (13/30) and 83.3% (25/30) respectively, with a statistically significant difference (χ ²=10.335, P=0.001). The median overall survival in the standard dose group and high dose group were 11 months and 9 months respectively, with no statistically significant difference (χ ²=1.490, P=0.256). Conclusion There are no statistical differences in short-time efficacy, symptom remission and long-term prognosis between the standard dose group and the high dose group in patients with advanced esophageal squamous cell carcinoma. However, the incidence of adverse reactions in patients receiving standard dose radiotherapy is low, which is worthy of clinical application.

Key words: Esophageal neoplasms, Neoplasms,squamous cell, Neoplasm metastasis, Radiotherapy, Treatment outcome

Wang Bin, Zhou Jiangyun, Liu Xi. Analysis of the clinical value of different radiotherapy schemes in patients with advanced esophageal squamous cell carcinoma[J]. Journal of International Oncology, 2021, 48(8): 484-488.

Figures/Tables 5

References 16

[1]	Siegel RL, Miller KD, Fuchs HE, et al. Cancer statistics, 2021[J]. CA Cancer J Clin, 2021,71(1):7-33. DOI: 10.3322/caac.21654. doi: 10.3322/caac.21654
[2]	Torre LA, Bray F, Siegel RL, et al. Global cancer statistics, 2012[J]. CA Cancer J Clin, 2015,65(2):87-108. DOI: 10.3322/caac.21262. doi: 10.3322/caac.21262
[3]	Watt E, Whyte F. The experience of dysphagia and its effect on the quality of life of patients with esophageal cancer[J]. Eur J Cancer Care (Engl), 2003,12(2):183-193. DOI: 10.1046/j.1365-2354.2003.00376.x. doi: 10.1046/j.1365-2354.2003.00376.x
[4]	Javle M, Ailawadhi S, Yang GY, et al. Palliation of malignant dysphagia in esophageal cancer: a literature-based review[J]. J Support Oncol, 2006,4(8):365-373.
[5]	Mellow MH, Pinkas H. Endoscopic laser therapy for malignancies affecting the esophagus and gastroesophageal junction[J]. Arch Intern Med, 1985,145(8):1443-1446. pmid: 4026476
[6]	Litiere S, Collette S, de Vries EG, et al. RECIST-learning from the past to build the future[J]. Nat Rev Clin Oncol, 2017,14(3):187-192. DOI: 10.1038/nrclinonc.2016.195. doi: 10.1038/nrclinonc.2016.195
[7]	Zhang Y. Epidemiology of esophageal cancer[J]. Word J Gastroenterol, 2013,19(34):5598-5606. DOI: 10.3748/wjg.v19.i34.5598. doi: 10.3748/wjg.v19.i34.5598
[8]	Stahl M, Mariette C, Haustermans K, et al. Oesophageal cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up[J]. Ann Oncol, 2013, 24 Suppl 6: vi51-vi56. DOI: 10.1093/annonc/mdt342. doi: 10.1093/annonc/mdt342
[9]	Martin-Richard M, Díaz Beveridge R, Arrazubi V, et al. SEOM Clinical Guideline for the diagnosis and treatment of esophageal cancer (2016)[J]. Clin Transl Oncol, 2016,18(12):1179-1186. DOI: 10.1007/s12094-016-1577-y. doi: 10.1007/s12094-016-1577-y pmid: 27900538
[10]	Suzuki G, Yamazaki H, Aibe N, et al. Palliative radiotherapy in the local management of stage ⅣB esophageal cancer: factors affecting swallowing and survival[J]. Anticancer Res, 2017,37(6):3085-3092. DOI: 10.21873/anticanres.11664. doi: 10.21873/anticanres.11664 pmid: 28551648
[11]	Hayter CR, Huff-Winters C, Paszat L, et al. A prospective trial of short-course radiotherapy plus chemotherapy for palliation of dysphagia from advanced esophageal cancer[J]. Radiother Oncol, 2000,56(3):329-333. DOI: 10.1016/s0167-8140(00)00225-5. doi: 10.1016/s0167-8140(00)00225-5 pmid: 10974382
[12]	Yamashita H, Okuma K, Nomoto A, et al. Extended cancer-free survival after palliative chemoradiation for metastatic esophageal cancer[J]. World J Gastrointest Oncol, 2014,6(2):52-54. DOI: 10.4251/wjgo.v6.i2.52. doi: 10.4251/wjgo.v6.i2.52
[13]	Akl FM, Elsayed-Abd-Alkhalek S, Salah T, et al. Palliative concurrent chemoradiotherapy in locally advanced and metastatic esophageal cancer patients with dysphagia[J]. Ann Palliat Med, 2013,2(3):118-123. DOI: 10.3978/j.issn.2224-5820.2013.05.01. doi: 10.3978/j.issn.2224-5820.2013.05.01
[14]	Prasad NR, Karthigeyan M, Vikram K, et al. Palliative radiotherapy in esophageal cancer[J]. Indian J Surg, 2015,77(1):34-38. DOI: 10.1007/s12262-013-0817-4. doi: 10.1007/s12262-013-0817-4
[15]	Anbai A, Koga M, Motoyama S, et al. Outcomes of patients with stage ⅣA esophageal cancer (Japanese classification) treated with definitive chemoradiotherapy[J]. Jpn J Radiol, 2013,31(4):270-276. DOI: 10.1007/s11604-013-0180-1. doi: 10.1007/s11604-013-0180-1
[16]	Guttmann DM, Mitra N, Bekelman J, et al. Improved overall survi-val with aggressive primary tumor radiotherapy for patients with metastatic esophageal cancer[J]. J Thorac Oncol, 2017,12(7):1131-1142. DOI: 10.1016/j.jtho.2017.03.026. doi: S1556-0864(17)30339-8 pmid: 28461255

项目	高剂量组 (n=30)	标准剂量组 (n=30)	χ²值	P值
年龄(岁)
<70	23(76.7)	26(86.7)	1.002	0.317
≥70	7(23.3)	4(13.3)
性别
男	26(86.7)	26(86.7)	<0.001	>0.999
女	4(13.3)	4(13.3)
KPS评分(分)
<80	7(23.3)	5(16.7)	0.417	0.519
≥80	23(76.7)	25(83.3)
肿瘤直径(cm)
<2	10(33.3)	8(26.7)	0.317	0.573
≥2	20(66.7)	22(73.3)
肿瘤长度(cm)
<5	9(30.0)	16(53.3)	3.360	0.067
≥5	21(70.0)	14(46.7)
同步化疗
有	25(83.3)	28(93.3)	0.647	0.421
无	5(16.7)	2(6.7)

组别	0分	1分	2分	3分	4分
高剂量组(n=30)	0	0	7	20	3
标准剂量组(n=30)	0	0	7	19	4
Z值	1.232
P值	0.876

组别	0分	1分	2分	3分	4分
高剂量组(n=30)	3	8	10	8	1
标准剂量组(n=30)	4	10	12	4	0
Z值	1.506
P值	0.278