Clinical results of intensity-modulated radiotherapy for 250 patients with cervical and upper thoracic esophageal carcinoma

Figures & data

Table 1 Clinical characteristics of 250 patients of cervical and upper esophageal carcinoma treated with intensity-modulated radiotherapy

Clinical characteristics	Number of cases (%)	Cervical segment	Upper thoracic segment
Sex
Male	192 (76.8%)	39 (72.2%)	153 (78.1%)
Female	58 (23.2%)	15 (27.8%)	43 (21.9%)
Age (years)
≥65	90 (36%)	17 (31.5%)	73 (37.2%)
<65	160 (64%)	37 (68.5%)	123 (62.8%)
Clinical stage
Stage Ⅱ	40 (16%)	10 (18.9%)	30 (15.5%)
Stage Ⅲ	41 (16.4%)	9 (17.0%)	32 (16.0%)
Stage Ⅳ	169 (67.6%)	35 (64.2%)	134 (68.4%)
T stage
T2	20 (7.8%)	4 (7.5%)	16 (7.9%)
T3	65 (25.9%)	16 (30.2%)	49 (24.7%)
T4	165 (66.3%)	34 (62.3%)	131 (67.4%)
N stage
N0	66 (26.4%)	16 (29.6%)	50 (25.5%)
N1	88 (35%)	21 (38.9%)	67 (33.9%)
N2	79 (31.7%)	16 (29.6%)	63 (32.3%)
N3	17 (6.9%)	1 (1.9%)	16 (8.3%)
Concurrent chemotherapy
Yes	172 (67.9%)	40 (74.1%)	132 (67.3%)
No	78 (32.1%)	14 (25.9%)	64 (32.7%)
Simultaneously integrated boost
Yes	146 (58.1%)	34 (62.3%)	112 (56.9%)
No	104 (41.9%)	20 (37.7%)	84 (43.1%)
GTV
≥32 cm^3	130 (50.2%)	21 (40.0%)	109 (53.1%)
<32 cm^3	120 (49.8%)	33 (60.0%)	87 (46.9%)
Lesion length (cm)
Range	3–27	3–8.6	3–27
Median length	6.5	4.2	6.5
Dose (Gy)
Range	48–70	48–66	48–70
Median length	60	60	60

Abbreviation: GTV, gross tumor volume.

Figure 1 Survival curves of 250 patients of cervical and upper esophageal carcinoma treated with IMRT. (A) The overall survival of patients; (B) the progression-free survival of patients.

Figure 2 Comparison of survival curves of patients with different radiotherapy dose. (A) The overall survival of patients with different target dose; (B) the progression-free survival of patients with different target dose.

Table 2 Univariate analysis of 250 patients of cervical and upper esophageal carcinoma treated with IMRT

Clinical characteristics	Median OS (months)	Overall survival rate		P-value	Median PFS (months)	Progression-free survival rate		P-value
		1 year	3 year			1 year	3 year
Age (years)				0.002				0.696
≥65	42.71	0.77	0.56		16.59	0.63	0.24
<65	18.96	0.69	0.28		14.39	0.69	0.32
Sex				0.586				0.209
Male	21.32	0.73	0.43		18.66	0.57	0.27
Female	21.32	0.78	0.39		18.66	0.65	0.37
GTV (cm^3)				0.046				0.108
≥32	20.46	0.64	0.37		10.94	0.49	0.29
<32	40.44	0.83	0.48		16.70	0.66	0.36
Dose				0.002				0.018
≥60 Gy	34.46	0.81	0.49		17.28	0.64	0.32
<60 Gy	17.64	0.61	0.30		10.94	0.48	0.28
Concurrent chemotherapy				0.013				0.039
Yes	30.62	0.79	0.47		15.84	0.63	0.35
No	18.60	0.65	0.30		10.94	0.49	0.18
Adjuvant chemotherapy				0.004				0.052
Yes	22.14	0.72	0.42		15.70	0.60	0.34
No	11.33	0.75	0.42		13.77	0.59	0.29
T stage				0.012				0.232
T2	40.48	0.81	0.53		34.20	0.70	0.38
T3	38.41	0.86	0.50		17.45	0.67	0.29
T4	18.76	0.69	0.36		13.14	0.54	0.29
N stage				0.002				0.089
N0	38.41	0.83	0.50		16.72	0.65	0.31
N1	31.70	0.77	0.46		17.54	0.62	0.36
N2	18.27	0.68	0.21		12.03	0.52	0.22
N3	12.58	0.53	0.13		12.58	0.40	0.20
Clinical stage				0.004				0.168
Stage Ⅱ	38.41	0.86	0.64		20.24	0.71	0.40
Stage Ⅲ	25.82	0.85	0.42		17.45	0.67	0.31
Stage Ⅳ	18.76	0.69	0.36		13.14	0.53	0.29

Abbreviation: GTV, gross tumor volume.

Table 3 Multivariate analysis of 250 patients of cervical and upper esophageal carcinoma treated with IMRT

Clinical characteristics	Median OS			Median PFS
	95% CI	HR	P-value	95% CI	HR	P-value
Age (years)	1.013–1.062	1.037	0.002
≥65
<65
Dose	0.455–0.857	0.624	0.004	0.556–0.916	0.714	0.008
<60 Gy
≥60 Gy
GTV (cm^3)	0.688–1.754	1.098	0.694
≥32 cm^3
<32 cm^3
Concurrent chemotherapy	0.512–1.490	0.874	0.620	0.467–0.960	0.670	0.029
Yes
No
Adjuvant chemotherapy	0.437–1.157	0.711	0.170
Yes
No
T stage	1.140–2.763	1.775	0.011
N stage	0.982–1.651	1.273	0.069

Abbreviation: GTV, gross tumor volume.

Table 4 Recurrence of 250 patients of cervical and upper esophageal carcinoma treated with IMRT

	Median OS (months)	1-year survival rate	2-year survival rate	3-year survival rate	P-value
Overall recurrence	15.34	61.4%	26.6%	16.6%	0.012
Local recurrence	16.92	73.7%	27.5%	17.9%
Lymph node recurrence	30.62	78.2%	56.5%	43.0%
Distant metastasis	15.84	60.1%	28%	11.7%

Table 5 Radiation-related complications of 250 patients of cervical and upper esophageal carcinoma treated with IMRT

Toxicity	Grade 0 (%)	Grade 1 (%)	Grade 2 (%)	Grade 3 (%)	Grade 4 (%)
Hematologic toxicity
Leukocytopenia	139 (55.6%)	61 (24.4%)	30 (12%)	6 (2.4%)	1 (0.4%)
Hypohemoglobin	123 (49.2%)	98 (39.2%)	14 (5.6%)	2 (0.8%)	0
Thrombocytopenia	185 (74%)	40 (16.0%)	10 (4%)	2 (0.8%)	0
Radioactive esophagitis	159 (63.6%)	25 (10.0%)	36 (14.4%)	15 (6%)	2 (0.8%)
Radiation pneumonia	205 (82%)	22 (8.8%)	3 (1.2%)	7 (2.8%)	0

Table 6 Results of radiotherapy and surgery for cervical and upper thoracic esophageal

Authors	Total no. of cases	Location	Treatment	Median overallsurvival (months)	Overall survival rate
1 year	2 year	3 year
Wang et al^Citation18	78	Upper	Surgery	13.1	53.9%	–	28.7%
Zhu et al^Citation20	30	Upper	IMRT	–	65.0%	50.0%	35.0%
Manshanden et al^Citation19	30	Upper	Surgery	10.0	–	–	–
Esmati et al^Citation21	40	Cervical and upper	3DCRT	19.2	76.0%	38.0%	16.0%
Li et al^Citation9	92	Cervical	3D/IMRT	36.0	88.0%	66.3%	49.8%
Cao et al^Citation17	27	Cervical	Surgery	–	–	50.7%	–
Present study	54	cervical	IMRT	20.37	75.2%	46.4%	38.7%
Present study	196	Upper	IMRT	25.8	74.2%	50.1%	41.1%

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